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PoST-MoRTEMS; 



WHAT TO LOOK FOR 



HOW TO MAKE THEM 



WITH SECTIONS ON 



Iflfanticide, Poisons, Malformations, Etc. 



By A. H. NEWTH, M.D., 

LONDON. 



:K^^ 



EDITED, WITH NUMEROUS NOTES AND 
ADDITIONS, 

By F. W. OWEN, M.D., 

Demonstrator of Anatomy in the Detroit College 
of Medicine. 






published by 

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Detroit, Mich. 



COPyRIGHTED, 1885. 



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PREFACE. 

This Manual is intended to serve as a re- 
minder to the busy practitioner, and a guide to 
the student, of what is to be done and observed 
in making post-mortem examinations, and also 
to assist them in describing and understanding 
the various lesions which may be met with. 

It is not intended as a substitute for large 
pathological works, but as a supplement to 
them. Disputed points in pathology have 
been specially avoided, and the lesions are 
described as simply and concisely as possible. 

Very few notes have been made on the mi- 
croscopical appearances in disease, as they 
would have increased the size of the work too 
much, and also have exceeded its purpose. 

The principal works consulted here have 
been : Aitken — Science of Medicine ; Chue-ch- 
iLii — Diseases ofWomen; Manual of Midwifery ; 
Delafield — Post-mortem Examinxitions; Druit 
— Surgeon^ s Vade-mecum ; Goubert — Manual 
de VArt des Autopsies; Gray — Anatomy; 
Green — Pathological Anatomy; Guy and 
Ferrier — Forensic Medicine; Harley and 
Brown — Demonstrations of Microscopic Anat- 
omy; Jones and Sieveking — Pathological 
Anatomy; Orth — Diagnosis in Pathological 
Anatomy ; Yirchow — Post-mortem Examina- 
tions; WiLKS AND MoxoN — Lecturcs on Patho- 
logical Anatomy, 

The Authors. 



INTBODUCTORY. 



Before commencing a necroscop}^ {rSKpo^, 
death; (SKOTteiv, to examine) it is necessary 
to consider well the purpose of this examina- 
tion. In medico-legal examinations it is of 
course to assist in detecting crime, and hence 
to determine whether death was the result of 
disease or violence; and if the latter, whether 
the circumstances preclude the possibility of 
suicide or accident, 

In disease, where there is no doubt as to the 
cause of death, we have to consider from the 
lesions not merely the settlement of patho- 
logical questions, though these are import- 
ant, but the determination of how far the dis- 
ease might have been amenable to treatment. 
We have to search for the remote cause of the 
symptoms which had been observed during 
life. It is not pretended, in our present state 
of knowledge, that we shall as yet do much 
in this respect; we have to collect, observe, 
and collate facts, and then deduce results 
from them. The necessity, therefore, of most 
careful and extended necroscopies is obvious. 

Everything should be conducted.by method ; 
all that is likely to be required must be duly 
considered and prepared beforehand, for the 
want of one little detail or necessary instru- 
ment or appliance may vitiate the entire ex- 
amination. Notes must be carefully made at 



6 



INTRODUCTORY. 



the time; these may bo elaborated subse- 
quently, but the origiaal notes are to be pre- 
served. In describing the post-mortem le- 
sions, it is essential to give as much as possi- 
ble the actual appearances; and it is also 
necessary to remember that as there are dis- 
eases of which the lesions are as yet not 
found, so there are lesions which do not cor- 
respond to any known disease; and that most 
of the lesions observed after death are sec- 
ondary to the disease itself. This is import- 
ant, as many mistakes have arisen from re- 
garding the lesions as of primary significance. 



POST-MORTEMS: 

WHAT TO LOOK FOR AND HOW TO MAKE 
THEM. 



EXTERNAL EXAMINATION OF THE 
BODY, 

This is necessary in every case, but espec- 
ially in medico-legal enquiries, and must on 
no account be carelessly passed over; the 
omission of a slight detail may have very dis- 
astrous consequences. 

Surroundings, note objects lying near, 

as well as position and state of the body; 

contents of the hands, their condition, 

whether horny, delicate, stained, clubbed- 

lingered, &c. 

The nails often contain matter suggesting cause 
of death and place where it occurred, as grass, 
weeds, dirt, hair (may correspond with that of the 
murderer), bits of clothing, &c. 

The limbs may be fractured, dislocated, 
bruised, &c. 

The nostrils and mouth may contain for- 
eign bodies and dust, which also may show 
locality, &c. 

Skin, — Look for burns, birth-marks, tattoo 
marks, tj^phus spots, osdema, sordes at orifi- 
ces of mouth and nose, pale yellow tint of 
cancerous diathesis, bronzing, ulcers, &c. 

Where there are purple streaks along the courses 
of the superficial vessels, the lining of the internal 
vessels and heart will be deeply stained with blood 
pigment, as well as the various organs, as liver, 
spleen, &c. This state must not be mistaken for 
inflammation; it is a sign of decomposition, and 
masks other appearances. 



POST-MORTEMS. 



Wounds. — Cuts, punctures, scars, &c. 
Notice the shape of the wound, direction, 
size (measure carefully, but remember that 
contraction may have taken place), appear- 
ance, edges everted or not, contain coagula, 
contiguous effusion. Marks of strangulation, 
bleeding from eyes, ears, vagina, &c. 

Bruises may be produced immediately 
after death; if caused during life there is 
always extravasation; in post-mortem dis- 
coloration the vessels are simply distended 
or surrounded by serum stained with blood 
pigment. 

Serious injuries, as fractures, may be caused with- 
out external signs. An abrasion of the cuticle ap- 
pears dry and hard, whether produced before or 
after death. It is often difficult to tell whether 
wounds are inflicted before or immediately, or even 
some time after, death. If there are signs of inflam- 
mation, cicatrization, or suppuration, it is easy to 
say. If the wound is everted and coagula are near, 
then it must have been done shortly before death. 

If several are lying dead together, 

try to find which died first, from circumstan- 
ces, position, &c., as well as appearance of 
the bodies. Estimate the period since 
death, but do so guardedly; remember that 
the condition is affected by the state of the 
weather. The temperature of the body is 
not always a safe guide, for it often rises as 
putrefaction sets in, and varies according to 
the state before death and the atmospheric 
temperature. 

Hair. — Notice the appearance of the hair, 
it may give important evidence — color, con- 
dition, pediculi, long and lanky (in wasting 
disease), curly and crisp (in health) — pubic 
hair and whiskers especially; in phthisis 
much hair often grows on the chest (Wilks 
and Moxon). 

Rigor mortis, if present, is a sign of 
recent death. The amount of fat on abdo- 
men often shows the kind of life that has 



EXTERNAL EXAMINATION. 



been led — sedentary, addicted to beer drink- 
ing, &c. 

Examine the nianimse for milk ; abdomen, 
&c., for signs of pregnancy, recent or remote. 

In suspected rape, look for semen in or 
Dear vagina or on the clothes; put some on a 
slide with warm serum, and examine under 
the microscope. 

Cause of death. — Sometimes the exter- 
nal appearance will afford some clue as to 
the cause of death — thus, wasted in phthisis, 
and especially in diseases of the abdominal 
viscera, when there is often what is called 
the *' abdominal face." In pneumonia Hiqtq 
is generally an herpetic eruption on the lips. 
The abdomen is distended in ascites and peri- 
tonitis (but decomposition produces disten- 
sion). There may be the peculiar mulberry 
rash of typhus fever (enteric shows none); the 
skin is yellowish in pymmia, and the lym- 
phatics are often affected (swollen, &c.) The 
color of the skin will also show heart dis- 
ease; a livid color deuoies pulmonary affection. 
Anasarca of arms, face, scrotum, &c., shows 
heart disease or kidney disease; of abdomen, 
liver disease; of one or both legs, that there 
may be a thrombus in the femoral artery. In 
general anasarca the blood is at fault. 

In looking: for post-mortem lesions in particular 
affections it must be remembered that a disease or a 
poison (as alcohol) takes possession of a person's 
weakest or^an, and shows its effect mostly there; 
hence the differences of appearances from the same 
cause. 

SIGNS OF DEATH. 

It is very important to attend to these — 
firstly, because the person may not be actu- 
ally dead ; and secondly, because the question 
might be put by some sharp counsel to the 
medical man whether he was sure at the time 
of making the necroscopy that the person 



10 POST-MORTEMS. 

was dead, and might request him to give 
proof of this. 

Vesalius was sadly troubled from having, as he 
fancied, noticed the heart beating after having 
opened a body. In the Pall Mall Gazette for June 
24, 1874, there is reported the case of a little girl who 
was pronounced by the medical man as dead, and 
placed in a mortuary. In the evening, when a necro- 
scopy was about to be made, the heart was found to 
be beating. Cases of presumed trance, or other un- 
certainty as to death, may be easily settled by care- 
ful attention to the signs of death. ^Iisi^:^-'^^' 

The hand being held up in a strong light, 
and the fingers extended and closely approxi- 
mated, the points where the fingers touch 
will show pinkish tinge during life, but pale 
and yellowish in death. 

The Eyes. — Dull, flattened, sometimes 
wrinkled, soft, flabby, and covered with a 
viscid mucus. After sudden death, as apo- 
plexy, poisoning by carbonic dioxide, hydro- 
cyanic acid, &c., the eyes may remain bright 
and distended for some time. 

Cadaveric Rigidity.— Not always pres- 
ent, or only for a very short time; electric 
stimulus may cause movements in those re- 
cently dead. 

Skin, — Peculiar pallor, livid or lead-col- 
ored in parts; mucous membrane exsanguine 
at natural orifices: palms of hands and soles 
of feet yellow; green color in iliac fossae (this 
is very characteristic if present); loss of tran- 
sparency and of the naturally pink color in 
thin parts, as web of finger, &c. If during 
life the loba of the ear or a finger is con- 
stricted by a tight ligature, there is a redden- 
ing of the constricted part; this becomes 
darker and darker till it is converted into a 
bluish red: just round the ligature there is a 
narrow white ring. After death these 
changes do not take place, which are of 
course due to the return of blood from the 
part being hindered by compression of the 



EXTERNAL EXAMINATION. 11 

veins. This is a certain sign of death, and 

is suggested by Dr. Magnus in Yirchow's 

*'Archiv." for 1873. 

The post-mortem change of color given here is sup- 
posed to be due to the action of sulphuretted hydro- 
gen on the albumin of the blood and tissues. 

Dr. Danis advises cutting down on an ar- 
tery — the temporal is the best — an empty state 
would show death. 

INFANTICIDE. — CHIEF MALFORMATIONS. 

Viability.— A child may live if born at 
the sixth month. The signs of having reached 
this age are: Length, from 8 to 13^ inches. 
Weight, 1 lb. to 2 lbs. 2 oz. Skin has some 
appearance of fibrous structure. Funis in- 
serted a little above the pubes. Limr of a 
dark red color. Points of ossification in the 
four divisions of the sternum. 

From this age the child increases in weight 
and length; the skin becomes more fibrous, 
and is covered with an unctuous matter, and 
fat appears in the subcutaneous tissue. 

6 to 7 months, Length, 11 to 12 in. ; Weight, 2 lbs. 

7 to 8 " *' 13 to 14 " " 3 to 4 lbs. 

8 to 9 " '* 15 to 16 *' " 4 to 5 " 

9 " " about 18 " '' 6 to 7 " 

Notice the measure from the vertex to the 
umbilicus, and from thence to the soles of 
the feet; state of the face (eyes, with or with- 
out membrana pupillaris), limbs (nails), gene- 
rative organs, position of testicles, points of 
ossification in the clavicle, maxillary hone, sa- 
crum, pubes, OS calcis, aster mim, stragalus, 
femur {lower end), &c. 

The point of ossification is easily obtained by ex- 
posing the end of the bone, and slicing the cartilage 
gradually till the o^sifla point is reached, which is 
of a deeper color than the cartilage. 

Shape of the liver, and comparative size of 
lobes; contents of gall bladder; length, color 
and quantity (lanugo) of hair should be noted. 



12 POST-MORTEMS. 



Intra-uterine Maceration is distinctive. 
Body is shrunken, bones softened; the skin 
appears as if boiled or poulticed, is slimy, 
and readily comes off in patches; face and 
generative organs of a deep red color; the 
subcutaneous tissue looks like gooseberry 
jelly. The umbilical cord is straight and 
flaccid. 

Respiration Test.— The proof of respi- 
ration is a proof of life. But — 1, respira- 
tion may take place before delivery; 2, it may 
be so partial as to escape detection; 3, an 
artificially inflated lung may give the appear- 
ance of a respired lung. 

All Unrespired Lung is like a piece of liver, 
of a uniform bluish-red color, and sinks in 
water. It may float from putrefaction, but 
pressure will easily expel the gases so formed 
and cause it to sink. 

A Respired Lung is nearly always pinkish — 
mottled if respiration is imperfect; the lighter 
patches are groups of air cells, which under 
the microscope have a very characteristic ap- 
pearance. 

Hydrostatic Test. — Put both lungs in a ves- 
sel of water, then each separately; then cut 
up into about twenty pieces, and test each of 
the pieces Take the piece or pieces that 
float, put it, or them separately, in a strong 
cloth, and squeeze under a board; then put 
in the water again. If they sink, the lung is 
an unrespired or an uninflated lung. 

Examine the Stomach for food; the In- 
testines for meconium; the Bladder for 
urine. Notice state of umbilical cord. 

Other facts proving life.— Obliteration 
of the umbilical arteries and vein, of the duc- 
tus arteriosus and venosus; closure of the 
foramen ovale. The patency of any of these 



EXTERNAL EXAMINATION. IB 

is no proof of sUll-hirth, nor can any definite 
period of survival be formed. 

The Skin in a few days exfoliates as a fine 
dust; this exfoliation is a decided proof of life. 

The Umbilical Cord shrinks and withers 
and becomes flabby, with sometimes a circle 
of a distinct red color round its insertion; 
this takes place in a few hours; in one or 
more days it dries up, and about the fifth day 
falls off; the wound cicatrizes about the 
eleventh day. 

Violence. — Fontanelles may be punctur- 
ed; instruments passed up vagina, rectum, 
&c. Saffocation. — Notice marks of pressure. 
Stomach may contain matters causing the 
suffocation (as faeces, feathers, &c.) Strangu- 
lation. — The cord may be twisted round the 
neck during delivery; measure the length of 
the cord, notice its state, see if it corresponds 
with the marks on the neck. Look for finger 
marks on the neck, and judge which hand 
caused them. Fractures of the Skull may be 
caused accidentally; Contusions, too; contu- 
sions and fractures may be produced during 
labor. 

Notice if the cord hasbeen properly attended 
to; if not, if the body is exsanguine; if the 
child has been exposed ; if starved. 

1. Large blood extravasations in the skin 
are always the result of external violence. 

2. Effusions of blood in the muscles of the 
neck and in the course of the great vessels of 
the neck point clearly to attempted strangu- 
lation. 

3. Haemorrhages between the liver and its 
capsule, and in the liver substance are always 
the result of external violence. 

In all these cases it is necessary to exclude difficult 
labors, operative measures and attempts at resus- 
citation. 



14 POST-MORTEMS. 



4. Lesions of the peritoneal membrane, and 
rupture of the liver, spleen and kidneys are 
due to violence ; they may be caused by the 
firm grasp of a hand round the child's body, 
and are not uncommon after attempts at 
artificial respiration. 

5. Haemorrhages in the umbilical cord are 
very rarely caused during the act of birth, or 
during attempts at replacement in cases of 
prolapse of the cord. They are almost al- 
ways due to violence of some form, especially 
to tearing the cord. 

6. Thick, circular, blood extravasations on 
the head or other parts of the body may be 
due to either diflicult labor or external vio- 
lence. 

7. Hemorrhages in the lips, muscles of the 
tongue, palate or gullet, should raise a sus- 
picion of violence (either operative or crimi- 
nal); this will be confirmed if slight wounds 
of the mucous membranes of the parts affected 
are found. 

8. Swelling of the lips — if not accounted 
for by the position of the face during partu- 
rition — must be considered a sign of the pres- 
sure of a hand on the child's mouth. 

9. Hemorrhage into the external auditory 
meatus and external ear was not observed in 
any of the cases. This is always due to exter- 
nal violence. 

10. Ecchymoses in the muscles, unless the 
result of difficult labor, etc., are always due 
to violence. 

11. If asphyxia is caused by immersing the 
child in some fluid medium, or in dust, this 
will very frequently be found in the nose, 
mouth, throat, stomach or lungs. 

12. Blood in the trachea, bronchi and alve- 
oli is usually due to aspiration from the ma- 
ternal passages or from the child's nose. 



EXTERNAL EXAMINATION. 15 

If the ecchymoses of the muscles are due to ope- 
rative interference and not to criminal acts, we must 
remember that the presentation of the child will 
probably have been norma', and in this case the 
caput succedaneum will not be on the head but on 
some other part of the body; therefore, the presence 
of a caput succedaneum on the head, with signs of 
external violence, will make us suspect criminal in- 
terference. 

The cases of death from asphyxia have the 
following special feaiures : In all the serous 
membranes and in the different mucous mem- 
branes, blood extravasations were found in 
the greater number of cases, and almost with- 
out exception, sub-pericardial and sub-pleural 
hemorrhages were present. 

Extravasations were also often present in the 
spleen, kidneys, thymus gland, the connective tissue 
surrounding the pancreas, and under the scalp, epi- 
cranial aponeurosis and pericranium. 

In the middle ear and nasal fossae there was 
almost always a dark-red discoloration of the 
mucous membrane, and in many cases also, 
blood was exuded. 

Hemorrhages into the conjunctiva and 
retina, and in the form of small striations in 
the vocal cords were of frequent occurrence. 

Extravasation into the tissue of the lungs 
was very rare, and blood was never found in 
the alveoli or bronchi unless it had come from 
the nose of the child, or from the genital 
passages of the mother, through respiratory 
efforts. 

If death had not been brought about very 
rapidly, oedema of the lungs, larynx and 
nasal mucous membrane was found, and 
sometimes interstitial emphysema; the latter, 
however, being not uncommon even in cases 
of rapid asphyxia. 

In the bones and muscles there were no 
changes except great fulness of the blood ves- 
sels. 

The above report is founded on post-mortem exam- 
inations of 178 children born at the ninth month; 138 
between the seventh and ninth, and 142 foetuses born 



alive between the fourth and seventh months, and 
is taken from Dr. Nobling's report in AerzJiches In- 
telligenzblatt. 



CHIEF MALFORMATIONS OF FCETUSES AND 
NEW-BORN CHILDREN. 

Absence of Organs, acephale (absence of 
head); anencephale (absence of braiu and 
spinal cord); congenital malformation (of 
idiots, cretins, &c.), congenital effusion of 
serum in the cerebral ventricles (with com- 
plete or incomplete development of the 
brain) or on the external surface; aprosopia 
(absence of face); absence of e3^es, eyelids, 
iris, mouth, lips, tongue, ear, epiglottis, 
penis, scrotum, testicles, vesiculse, ovaries, 
uterus, vagina, certain ribs or vertebrae, a 
part of a limb, hand, bladder, oesophagus, 
stomach, liver, heart, lungs, diaphragm, pan- 
creas, spleen, spinal cord(amyencephale), &c. 

Want of Union in Similar Parts.— 
Fissure in the median line, involving the cra- 
nium, the spinal column (spina bifida), the 
lips, the maxillary bones, tongue, roof of the 
palate, bladder, urethra, vagina, spleen, linea 
alba (with hernia). 

Inperforation of iris, eyelids, mouth, 
anus, urethra, vagina, uterus, intestines, 
oesophagus, valves of the heart, &c. 

Joining together of Organs.— Eyes 
(monopsia, cyclopsy); fusion of the lower 
limbs (symelia) or of the fingers (syndactyle). 

Atrophy, — Arrt^st of development in the 
limbs; feet or hands inserted on the trunk 
(phocomelia) ; incomplete limbs. 

Augmentation of Organs.— Double or- 
gans or increase in number (supernumerary 
limbs, &c.), &c. 

Heterogenesia. — Extra-uterine foetus; 
more than three feel uses at a time; foetus with 
change in the ordinary situations of the or- 



SIGNS OF DEATH FROM VIOLENCE, ETC. 17 

gan; hernia of heart (lissure of sternum), of 
the abdominal viscera into the thorax, &c. 

Double Monsters.— By fusion together 
of some part of the body; developed equally, 
unequall}^ &c. ; contained in one another (foe- 
tal inclusion). 



11. 

SIGISIS OF DEATH FROM VIOLENCE, 
POISONING, ETC. 

STARVATION, 

Emaciation in chronic cases is extreme, 
in acute cases less or even not at all. 
Stomach and Intestines empty, fauces dry; 
heart and bloodvessels generally empty; pu- 
trefaction is rapid and sets in early, and the 
body smells offensive. But disease may cause 
all these appearances. 

SUFFOCATION. 

Necroscopic signs not satisfactory. The 
Skin is generally of a uniform violet tint, with 
blackish ecchymotic spots. The Lungs fre- 
quently show punctiform ecchymoses and 
partial emphysema. The other organs are 
deeply congested. 

Suffocation, right side of the heart auricle 
and ventricle usually full of dark, clotted or 
fluid blood; left cavities empty; the conjunc- 
tiva may be congested or ecchymotic. The 
mouth often contains frothy blood and mucus. 

HANGING. 

Signs after death are those of suffocation. 
There is also the mark of the cord. This varies 
in position, depth, and appearance, accord- 
ing to the mode of hanging, struggles, weight 
of body, and material used. 

There may be only a depression, or the mark may 
be, after exposure, of a deep brown color. 



18 rosT-xMOUTE.\rs. 



Examine the vertebrae lor fracture or dislo- 
cation, as of the odontoid process. 

The Tongue IS general!}^ swollen at the base, 
injected, and sometimes protruded. 

The penis is more or less erected, sometimes 
with emission; in females the genital organs 
are swollen and red. Faeces often expelled. 

DROWNING. 

Appearances vary very much, according to 
the mode of death; this may be from apnoea, 
exhaustion, syncope, apoplexy, shock, blow 
on the water from projection, cold, &c. , or any 
of these together. 

The Tonrjue is swollen at the base; the Skin 
is pale, with violet or rose-colored patches; 
Lungs, brain, kidneys, &c., congested; left 
side of Heart empty, right side full of blood. 
These are signs of apnoea. 

Special Signs of Drowning are— mud, 
sand, water-plants, &c., in the hands, nails, 
ears, nostrils, &c. ; fingers often excoriated. 
Water, &c., in the Lungs; this may, how- 
ever, enter after death ; water in the Stomach 
is a very strong presumptive evidence. Re- 
traction of the penis, cutis anserina, froth in 
the mouth and nostrils, ma}'' also be noticed. 

A chemical analysis of the water might at times 
afford valuable evidence. 

Submersion during Life or after 
Death. — Dr. Bougier, from experiments and 
autopsies at the morgue, formulates the fol- 
lowing conclusions: 

1. The exterior aspect of the body is about 

the same in both cases. 

The appearance of moss on the body, weeds or 
sand grasped, in the hands would be of some diag- 
nostic value. 

2. Water and foreign bodies penetrate into 
the air-passages and into the bronchial tubes 
of those submerged before, as well as those 



SIGNS OF nE.\Tir FROM VIOLENCE, ETC. 19 

submerged after death ; hut in the latter the 
foreign bodies do not go beyond the fifth or sixth 
divisions of the bronchial tubes, and the liquid 
is arrested at the bronchi of medium size by 
the column of compressed air ; whereas, in 
the submerged during life, it penetrates doion to 
the small bronchial tubes. 

3. The epiglottis is vertical in the sub- 
merged; it is only half open in the corpses 
immerged 

4. Water penetrates in a pretty large quan- 
tity to the stomach of the former, but never to 
that of the latter (after death) ; and in making 
a comparative analysis of the liquid found in 
the bronchial tubes, one might arrive at a cer- 
tain diagnosis. 

5. The same is the case with the middle 
ear. 

0. The characteristic moss is found only in 
the submerged. 

7. If the fluidity of the blood exists in cer- 
tain cases of poisoning by opium, it is easy by 
the aid of the spectroscope, and by analysis, 
to form the diagnosis. 

8. In putrefied corpses, all the signs have 
nearly disappeared, and the medical jurist 
can only draw conclusions by presumptions. 

POWDER MARKS IN CASES OF DOUBTFUL 
SUICIDE. 

Dr. Fisk {Boston Medical Journal) concludes 
an able exposition of this perplexing subject 
thus: 

1. From a great distance the entrance 

wound will usually be large and irregular; 

there loill be absence of any great degree of livid- 

ity of its edges, and absence of powder marks. 

The wound of exit, if one be present, will 

usually be larger than the loound of entrance. 

At any distance the edges of wounds of entrance 
wiU usuaUy be inverted, those of exit everted. 



20 POST MORTEMS. 



2. Prom a short distance the entrance 
and exit wounds will generally be nearly 
equal in size; the edges of the former will be 
blackened, and the powder grains will be im- 
bedded in the skin, but there will be absence 
of the scorchings and brandings of powder. 

3. Close to the body the entrauce 
wound will general!}' be larger than the exit. 
There will often be, in addition to the tattoo- 
ing of the skin by un burnt grains of powder, 
a mark or brand made by the flame of the 
gases of the burning powder, by the soot of 
the partly burned powder and by the residue 
of ash of the wholly burned powder. 

As a rule this brand, which may consist of a burn- 
ing alone of the hair, the skin, or of the clothing, or 
of a burning and blackening of the skin or clothing, 
will appear at one side of the bullet hole. 

The position of the weapon is to be 

determined thus: When the brand appears 
upon the hair, the skin or clothing at one side 
of the bullet hole, hold the weapon with its 
muzzle to the bullet hole so that the line of 
its hammer and sight will meet a linedrawn 
from the centre of the bullet hole through 
the centre of the brand and it will show the 
exact position of the weapon when tired. 

Accidental Wounds are generally near 
wounds. When inflicted from a distance they 
cannot be distinguished from homicidal 
wounds. 

In shots fired near by, when a person is 
known to have been shot standing, an un- 
natural position of the weapon, as shown by 
the location of the brand, will tend to corrob- 
orate the claim of accidental shooting. So 
if one is knoicn to have shot himself an un- 
natural position of the weapon will show that 
the shot was probably accidental. 

The location of the wound and the course taken by 
the ball may also characterize the wound as acci- 
dental. 



SIGNS OF DEATH FROM VIOLENCE, ETC. 21 

To distinguish Homicidal from Sui- 
cidal Wounds. — When the location of the 
brand, relative to the bullet hole, shows that 
the weapon has been held in a position of its 
hammer aud sight impossible or improbable 
for a suicide, it is probable that a murder has 
been committed. 

Certain relative locations of this brand may also 
indicate that the victim has been shot while in a re- 
clining position. 

Multiple toounds are usually homicidal, but 
may be either accidental or suicidal. Shots 
fired beyond the usual suicidal limit are prob- 
ably homicidal. 

It is said that the suicide rarely holds the muz- 
zle of his pistol more than eight inches from his 
body. Suicides generally fire at the side or 
front of the head, next to the heart; some- 
times at the back of the head. 

The distance from the body at which 
the weapon must be held to show the brand 
plainly is very nearly as follows: For small 
pistols and revolvers, not over four to six 
inches. 

For large weapons of this class, not over 
twelve or fourteen inches. 

POISONS. 

The necroscopic appearances in cases of 

poisoning are not always very decided, and 

great care must be taken to avoid drawing 

incorrect inferences. 

In some cases there are no post-mortem signs at 
all, and it is only when a strong corrosive poison has 
been taken that they are at all decided. 

The necroscopy in these cases must he per- 
formed loith extreme caution in the presence of 
om or 7)iore competent toitnesses. All instru- 
ments, vessels, and appliances of every kind 
must be scrupulously clean. 

The jars, bottles, or other vessels to con- 



POST-MORTEMS. 



tain the portions selected for chemical or 
other analysis should be washed out with 
water, then with strong sulphuric acid, again 
with water, and finally with distilled water. 

Stomacli. — Both ends of the stomach are to 
be securely tied up with double ligatures, se- 
cured by a pin to prevent slipping, and separ- 
ated by cutting between these. It is well, 
sometimes, to put it up whole in a jar for 
more leisurely examining it, or for a more 
competent person to do so ; it must be remem- 
bered, however, that the gastric juice may act 
on the coats and destroy them, it is therefore al- 
ways best to put the stomach and contents in 
separate vessels. 

If it is wished to examine it at once, put the 
contents in a clean jar; lay the organ on a 
clean flat surface, as a dish or piece of glass; 
open it along its smaller curvature. Look care- 
fully for leaves and seeds of plants, powders, 
&c. 

Tie both jars over with gutta-percha tissue, 
first putting a cork or stopper in if there is 
one, then a piece of white paper over this, 
and seal it so that they cannot possibly be re- 
moved without breaking the seal, and use a 
stamp that is not likely to be imitated; fasten 
a label to each jar or bottle, with the name of 
the contents, the date, and the signature of 
the necroscopist. 

The liver, kidneys, spleen, intestines 
and brain, or portions of these, should each 
be put in a separate vessel, and also carefully 
sealed and labelled. Where, however, the 
jars are taken straight to the analyst by the 
necroscopist, there is not so much w^ed to seal 
them, yet it is far better to do so in all cases. 

In making the necroscopy the intrusion of 
foreign bodies must be carefully guarded against, 
especially if they are of a metallic nature, as 



SIGNS OF DEATH FROM VIOLENCE, ETC. 23 

pins, needles, nails, copper rings, bits of col- 
ored paper, pieces of sealing wax, &c. The 
accidental presence of any of these with the 
part to be analysed might spoil the whole 
analysis. 

31^* Poisons may be introduced per rectum 
or per vaginam, or endermically and hypoder- 
mically. 

2;^* Remember, Karcotics — as Opium, 
Belladonna, Ilyoscyamus, Camphor, &c. — give 
no satisfactory necroscopic appearances. Con- 
gestion of the brain has been met with, and a 
few other signs supposed to point to the cause 
of death. Belladonna, hyoscyamus, and 
camphor have each a peculiar smell, which 
may be more perceptible after gently warm- 
ing the contents of the stomach. The seeds 
of belladonna and hyoscyamus may be dis- 
covered. 

Alcohol, JEtlier, Chloroform, Hydrate of 
Chloral, c%c , produce inflammation of the 
stomach and bowels, and the characteristic 
odor of each will serve to distinguish them. 

Strychnia leaves no decided signs of its 
presence; the muscular spasm soon passes off, 
but the hands may remain clenched, &c. 

The Metallic Poisons show few post- 
mortem signs, nitrate of Silver is turned into 
chloride, which adheres to the mucous mem- 
brane in the form of curdy flakes, and the 
oesophagus and stomach are eroded. 

Copper causes inflammation, thickening, 
and sometimes ulceration of the mucous mem- 
brane, which is changed to a green color. The 
skin is often yellow. 

Antimony and Arsenic generally produce 
inflammation of the stomach and intestines, 
but not always. In arsenical poisoning the 
solid metallic oxide may be seen adhering in 
patches to the mucous membrane ; this often 



24 POST-MOKTEMS. 

turns yellow, when decomposition sets in. by 
the formation of the sulphide. The contents 
of the stomach are generally of a brown 
color. 

Phosphorus. — This also produces patchy in- 
flammation, and particles of the substance 
may be found (as heads of matches, &c.) in 
contact. The skin is of a peculiar yellow tinge, 
and there is frequently extensive fatty degen- 
eration of the muscles, liver, &c. 

Various Salts of an irritant nature, when 
taken in large doses, may be poisonous, as 
Potassium Nitrate, Sulphate, Acid Tartrate, 
and Sulphide; Alum, Sodium Chloride, Chlor- 
inated Soda, Lime, Potash, &c. ; Barium 
Salts, also Iodine. These occasion inflamma- 
tion of the stomach and intestines, with secre- 
tion of a slimy mucus, thickening of the coats, 
hypersemia of the vessels; sometimes ulcera- 
tion. Potassium Sulphide deposits sulphur. 

Alkalies. — Sod<t, Potash, Ammonia and 
their Carbonate.^ generally produce softening 
and corrosion of the mucous membrane, with 
inflammation and extravasation of blood in 
patches; ammonia causes more extensive in- 
flammation. Cyanide of PotaMium is also a 
caustic alkali. 

Acids — as Sulphuric, Nitric, Hydrochloric, 
Oxalic, Carbolic, &Q,. — occasion more or less 
corrosion in the mouth, on the lips, chin, &c.. 
varying according to the amount and 
strength of tbe acid. There is considerable 
inflammation, often oedema and contraction of 
the parts touched by the acid. The glottis 
may be closed by this swelling and contrac- 
tion. 

The contents of the stomach are generally a 
sticky liquid of a black, yellow, or brown 
color, and it is distended with gas. 

The mucous membrane of the oesophagus 



INTERNAL EXAMINATION. 25 

and stomach may either be detached, shriv- 
elled, or converted into a lohite (sulphuric 
acid), yelloio (nitric), or broioa substance 
(oxalic, &c.); sometimes the walls are per- 
forated. (See Sections on the ** Stomach " and 
'•'Intestines") 

Prussic Acid.— This can generally be 
easily distinguished by the smell. The fea- 
tures are often peculiarly lifelike — the eyes 
glistening, the cheeks colored, &c. The 
blood is of a bluish tint. 

Carbonic Acid. — There are signs of suffo- 
cation, bloated appearance, livid spots on 
body, distension of abdomen; eyes glistening 
and prominent. The blood is of a dark color, 
and the right cavities of the heart are gorged. 



III. 

INTEBNAL EXAMINATION OF THE 

BODY. 

Order. — 1, Abdomen; 2, Thorax and Neck ; 
3, Cranium; 4, Spine; 5, Limbs. 

Special wounds or other injuries, or parts 

to be examined particularly — as vagina in 

rape, throat in suffocation or poisoning, &c. — 

should receive the first attention; wounds 

must be carefully probed and cut down upon. 

In sudden death of children always carefully ex- 
amine the mouth at an early stage for foreign bodies, 
or for marks of compression of throat or mouth. 

METHOD OF OPENING THE BODY. 

There are seveial ways of opening the body, 
but the best is by a longitudinal incision from 
the symphysis pubis to the xyphoid cartilage, 
passing to the left of the umbilicus, and thence 
to the sternal notch; in cases where the 
throat is to be examined the incision on the 
chest is to be carried on to the chin. 



26 POST-MORTEMS. 



The incision may be made through the fat and 
muscles to the bone, and, unless great care is re- 
quired, right through the abdominal walls; then the 
muscles, skin, and fat are to be dissected off the 
chest, and turned aside. 

The position of the diaphragm, and its re- 
lation should now be examined — this may 
give some idea as to the cause of death, 
especially in the case of new-born children — 
and the position, abnormalities, appearance, 
&c., of the abdominal contents, without dis- 
turbing them. 

Then proceed to open the thorax ; divide 
the cartilages of the ribs as near the bone as 
possible; in cases of ossification use the bone 
forceps; cut from loithin outwards, so as not to 
injure the contents of thorax. Disarticulate 
the sterno-clavicular joint, raise the sternum, 
dissecting it from its connections, diaphragm, 
&c. , and remove. Fold the skin of the chest 
over the ends of the ribs, especially if the bone 
forceps have been used, in order to protect the 
Jiands and arms from injury by the ends of the 
ribs. 

Examine the p^^w?'^ for hydrothorax, hsema- 
thorax, and pneumothorax (do not mistake 
post-mortem hcrmorrhage from a wounded 
vein for ante-mortem hsemorrhage); also ex- 
amine the pericardium and the mediastinum. 

Remove the heart, tying the principal ves- 
sels first; then take out the lungs, either 
separately or together. 

To expose the tongue and back of the 
fauces carry the incision to the symphysis 
of chin and divide the lip, saw through the 
lower jaw a little on one side, cut through 
the muscles and the hyoid bone, and turn on 
one side, when the whole cavity of the mouth 
will be exposed. Or the incision may be car- 
ried to an inch below the chin; the skin, &c., 
dissected off ; the soft parts removed as much 
as possible; the mylo-hyoid and other mus- 



INTEKNAL EXAMINATION. 27 

cles divided close to the lower jaw, so as to 
expose the mouth; the tougue drawn down- 
wards and forwards through the opening, the 
pharynx divided as high as possible, which, 
with the larynx, is also to be drawn down. 
The attachments are separated, and thus the 
whole of the pharynx, hirynx and trachea 
may be removed en masse. 

In some cases three or four of the upper vertebrae 
may be removed, and the pharnyx opened from be- 
hind. 

The contents of the abdomen should 
be examined and removed in the following 
order: — 1, omenta; 2, stomach (tying closely 
both orifices first; a blunt pin or wure passed 
through the cut ends prevents the string slip- 
ping off); 3, spleen and pancreas; 4, intestines 
(notice first the ductus choledochus and ver- 
miform appendix; tie up both ends); 5, liver 
(take care not to injure the connections; it is 
sometimes well to remove it with the stomach 
and pancreas); 6, kidneys, 7, uterus and blad- 
der. 

Some recommend removing the whole of the vis- 
cera en masse, but it will generally be found most 
convenient and satisfactory to examine the organs 
in situ and remove separately, unless for special 
reasons. 

METHOD OF OPENING THE HEAD. 

Notice the state of the scalp; shave if neces- 
sary. Then make an incision from ear to ear 
across the parietal bones, dissect the integu- 
ments off the skull, and turn them over the 
face and occiput. 

Examine the skull carefully for fracture ; rub ink 
in if not very distinct; describe accurately the situa- 
tion of injury, depression of bones, &c. 

Cut a line round the head a little above the 
occipital protuberance and the frontal sinuses 
with the scalpel, as a guide for the saw. Then 
saw through the outer table of the skull care- 
fully, testing the depth occasionally with the 



28 POST-MO UTE MS. 

handle of the scalpel; break the inner table 

with the chisel and mallet. (If fracture is 

suspected, it is better to saw completely 

through.) Raise the skull cap by means of 

the handle of the mallet, or an iron lever. If 

there is adhesion of the dura mater, cut 

through it and remove it with the top of the 

skull. 

In infants the scissors may be passed into one of 
the fontanelles, and the bones cut with them. The 
fontanelles must first be examined very carefully for 
punctures, &c. 

NOTA BENE. 

In describing the morbid and other ap- 
pearances of an organ notice: 

Its position and relation to the surrounding 
parts, adhesions, fluids, and other matters in 
contact. 

Its shape, size, weight, color and odor. 

State of the surface — color, thickening, thin- 
ning, or adhesion of its natural covering; effu- 
sion beneath it, &c. 

Then notice the consistence, color, odor, ap- 
pearance, &c., of the parenchyma on section; 
contents of the organ. 

If pale, wash with water and test with 
iodine. 

Scrape the surface of the section with a 
knife and examine the scraping microscopi- 
cally for cancer, micrococci, bacteria, hyda- 
tids, &c. Inflate the lungs; use the hydro- 
static test. 



TO PRESERVE TISSUES FOR MAKING MICRO- 
SCOPICAL SECTIONS. 

The parts of the organs to be examined are 
cut up into pieces about the size of a chest- 
nut, and placed at once in Mliller's fluid, 
which will be found most convenient for gen- 
eral use. 



INTERNAL EXAMINATION. 29 

This solution is made by dissolving 20 to 30 parts of 
potassium bichromate and 10 parts of sodium sul- 
phate in 1000 parts of water. If Miiller's fluid is not 
at hand, a solution of common salt in water is use- 
ful to preserve, almost unchanged, the tissue for 
some time. 

The solution is to be renewed in eighteen 
hours, and every week subsequently for a 
month or six weeks or more ; the preparation 
is then often hard enough to cut sections 
from; but if not, it is to be put in spirit till 
hard, or in chromic acid 1 part, water 20, and 
rectified spirit (methylated) 180. 

The best way to preserve and harden several speci- 
mens is to suspend them in a large quantity of the 
fluid. A very good plan is to have a leech vase or a 
bell jar to contain the solution, and the pieces of tis- 
sue, weighted if necessary, fastened to silver wires, 
or silk cords or even fishing gut, of varying lengths, 
attached to pieces of cork, which will float them. 
The corks are to be numbered, and the numbers are 
to correspond with a register of the pathological 
specimens. The corks may be kept separate (if 
necessary) by small strips of wood stuck in them. 
By this means several hundred portions of tissue can 
be kept to harden in a comparatively small space. 
The fluid must be renewed od'asionally, and fresh 
portions of a stronger solution added frequently. 

TO SEW UP THE BODY. 

Fasten two curved needles one to each end 
of a waxed piece of cord four times the 
length of the part to be sewn. Begin at the 
symphysis pubis, pass each needle through 
the skin from within out, as near the edge 
of the incision as possible ; let the middle of 
the cord make the first stitch, then sew at 
regular intervals, passing the needle through 
the skin from within ; when several stitches 
have been made, draw the edges of the in- 
cision tightly, as in lacing, and fasten off by 
tying the ends. 

Head. — Place the skull-cap in position, 
and keep it so by two stitches passed through 
the ends of the temporal muscles and tied 
tightly together; cover with the scalp, and 
then sew this up. 



30 POST-MORTEMS. 



IV. 

OBGANS OF CIRCULATIOK 

PERICARDIUM. 

Examine it in situ ; it may be adherent, per- 
forated (from mediastinal abscess, aneurism, 
&c.); congenital defects are rare and uncer- 
tain; the membrane may be absorbed. 

Open the pericardium and remove the heart, first 
tying the large vessels and dividing them, cutting the 
aorta as high up as possible. 

Lesions of the External Surface.— 

Thickened, covered with false membranes, 
cartilaginous patches, 'milk' spots (uncertain 
what these are), ossiform plates, ulcerations 
(tubercular or cancerous), serous cysts, ecchy- 
moses, &c. 

Internal Surface. — Dry, wrinkled, 
sticky, roughened, granulated, adherent to 
the cardiac layer; bright rose color (acute 
pericarditis), punctated, coalescing into scar- 
let patches (more advanced pericarditis), 
'exudation.* 

Contents. — Serum (most common; there 
is normally about one-half oz. to one oz.)\ blood 
— from rupture, inflammation, purpuric state, 
&c. ; pus — generally laudable, sometimes 
greenish; an albumino-fibrinous fluid, of a 
sero-purulent or soupy nature, holding fibri- 
nous flocculi in suspension, or cellules of 
pavement epithelium, or fatty granules (gen- 
erally associated with fatty degeneration of 
the heart), &c. 

The quantity of serum may vary from half an ounce 
to two quarts, and the pericardium may then extend 
up to the second rib. Rokitansky has met with soft, 
yellow, beanlike bodies in the pericardium, but they 
are extremely rare. 

When there is much effusion, notice if the 
heart is displaced, if it floats, its form, vol- 
ume, &c. 



ORGANS OF CIRCULATION. 31 

Hy draper tear dium, the result of general dropsy, 
must not be con^■ounded with effusion of serum from 
inflammatory action; the serum in dropsy is of a 
lighter color. 

Pseudo-membranous Deposit. — Thick- 
ening of the natural tissue, or the formation 
of a fibrinous or cartilaginous (sometimes cal- 
careous) deposit; frequently like the stomach 
of a calf, or a honeycomb (long-continued 
pericarditis). 

Estimate the probable age of deposit by the extent 
of its adiiesion, its organisation, &c. When villous 
it is of long standing. 

Pericarditis, Acute.— Is^^ stage, injection 

with arborescent reddening, but this is seldom 

seen post mortem. In a day or two 2nd stage; 

fibrinous effusion forming a layer over the 

surface of the heart. 

In inflammation of longer standing there is thicken- 
ing of the fibrinous layer with serous effusion, and 
the surface gets shaggy. Sometimes the effusion is 
purulent. 

Chronic Inflammation.— The effused 
lymph organises, and several layers are 
formed ; there is often a fatty deposit on the 
surface of the heart immediately beneath the 
first layer. Sometimes there are calcareous 
patches. 

Adhesions, when simple, do not seem to 

interfere with the action of the heart much; 

but when the pericardium is attached to the 

heart by fibrous bands, then the muscular 

structure is injured. 

Cancer and Tubercle may be found, but they are 
secondary deposits. 

HEART. 

The normal size and weight vary considerably, 
it usually weighs from 9 to 12 oz. in males, 
and from 8 to 10 oz. in females; proportion to 
body weight, as 1 to 169 in males, and 1 to 
149 in females. 

Thickness of right ventricle to left, as 5 to 
13. Both cavities are of equal dimensions. 



32 POST MORTEMS. 



In order to distinguish the right side of the heart 
from the left, it is useful to remember that the 
tricuspid valve is on the right (dextral), and the mi- 
tral valve is on the left (sinistral) side. 

External Modifications.— Changes in 
the form, situation, direction, relations, 
weight, thickness of walls, &c. 

External Surface.— Change in the color 

of the fibres; they may be violet, red, grey, 

pale yellow (signs of fatty degeneration), &c. 

There may be ecchymosis (from injury, &c. ; post- 
mortem staining not to be mistaken for this); 'miW 
patches (probably fi'om alcoholism or rheumatism, 
though Dr. Wilks thinks they are due to attrition, 
a kind of wart, as from pressure of a belt on the 
chest). 

Hypertrophy. — General or limited ; 

eccentric, with dilatation of the cavities. 

Aneurismal pouches. 

Normal contraction (Systole) of the heart must not 
be confouiided with hypertrophy, though it has 
been described as concentric hypertrophj^; in systolic 
contraction the muscular structure can easily be 
stretched luifh the fingers, and the contraction passes 
off with the rigor mortis. 

Hypertrophy may be associated with fatty 

or fibroid degeneratioD, disease of the valves, 

aneurism >. disease of the luDgs, pericarditis, 

&c. ; any of these may be a cause. 

In granular kidney the heart is almost constantly 
found enlarged. 

Atrophy. — Simple, with dilatation, some" 
times with contraction; in wasting diseases 
or as a congenital defect. 

Dilatation of the Heart, with atrophy, 
is most frequent on the right side, and chiefly 
affects the auricles; often a result of endo- 
carditis and disease of the muscular fibres. 
It is a serious disease. 

Dilatation with hypertrophy of the walls 
is not so serious; it shows a conservative ten- 
dency. 

The state of diastole may be mistaken for simple 
dilatation. 

Partial dilatation, or aneurism; contents of 

the pouches vary according to length of the 



ORGANS OF CIRCULATION. 33 

disease; they may be blood, coagula, lami- 
nated fibrinous deposit, &c. 

The Coronary Vessels maybe congested 
or contain clots or purulent deposits; the walls 
may be atheromatous (cause of angina pec- 
toris), ossified, &c. 

Nerves of the Cardiac Plexus should be carefully 
examined. 

EXAMINATION OF ENDOCARDIUM. 

Open the heart by a V incision, with scis- 
sors which are inserted near the apex, one 
cut passing along the anterior groove, the 
other along the outer border, begin with the 
right ventricle. 

Examine the contents, and test the patency 
of the valves either with a stream of water or 
the fingers; aortic and pulmonary valves by 
a column of water in the vessels. Measure- 
ment of the orifices may be taken with a 
graduated cone or the fingers. 

Having examined the contents, state of the 
valves, &c., pass one blade of a long pair of 
scissors (enterotome) through the left ventricle 
up the infundibulum into the aorta, and di- 
vide where most convenient; the pulmonary 
artery may be opened in the same way through 
the right ventricle. 

Contents.— Clots. — Post-mortem are black 

or dark-colored, friable and humid, often 

covered with a fibro-albumlnous layer, not 

adherent to the parietes, with red corpuscles 

uniformly distributed through the clot. 

In the right ventricle and auricle the blood is buff 
anteriorly and red posteriorly: it is more fluid on the 
left side. 

Ante-mortem ('polypi ') are discolored, grey- 
ish or yellowish white, sometimes very white; 
have a fibrinous texture; are elastic, tenacious, 
resistent, more or less adherent to the walls, 
may be grooved by the passage of blood, 



34 POST-MORTEMS. 



occasionally organised. Sometimes they are 

softened internally to a creamy consistence. 

The importance of clots in the heart is not very- 
great; ante-mortem generally show lingering death. 
Asphyxia is incompatible with the formation of ante- 
mortem clots. In sudden death the blood is gener- 
ally fluid. In apnoea the right side of the heart is 
gorged, the left nearly empty. 

Color of Endocardium. — When pink 
shows acute endocarditis and must not be 
confounded with post-mortem stainiog. Post- 
mortem redness, from deposition of blood pig- 
ment, is more diffuse ; there will be fluid blood 
in contact, and the coloring matter may be 
washed off or removed by maceration. 

Endocarditis. — Inflammatory redness 
(seldom seen post-mortem) is generally in 
patches, and remains permanent; there are 
also other pathological effects, as softening of 
the muscular structure, &c. 

Diffuse inflammation causes a silvery opacity from 
deposition oi fibrin. There may also be atheroma, 
shown by opaque cheesy patches or calcareous 
plates. 

The endocardium in the left auricle is nat- 
urally whitish, as it is thicker there. 

The results of endocaiditis are serious, as embol- 
ism, fibroid degeneration, and dilatation; inflamma- 
tion generally affects the valves. 

* Milky Patches' are signs of localised 
chronic inflammatory action, most probably 
of rheumatic origin, or from alcoholism. 

Granulations or Vegetations are formed 
by a tilting up of the superjacent endothelium 
from deposition of inflammatory products in 
the connective tissue; they may become cal- 
careous. 

Endocardial Ulcer.— Rare, always be- 
gins in a valve, may lead to perforation or 
aneurism, very rarely to gangrene. 

Is met with chiefly in cases of blood-poisoning, but 
whether secondary or primary is uncertain. 

State of the Walls.— Notice their thick- 
ness, size of the cavity, &c. Muscular struc- 



ORGANS OF CIRCULATION. 35 

ture firm, friable, granular or lardaceous, 

fatty, &c. 

The muscular structure should be macerated in 
dilute acetic acid or alcohol, in order to examine it 
under the microscope; fibres being teased out by- 
needles and placed in glycerine. 

Tumours,— as lipoma, fibroma, carcinoma, 
cystic, tubercular, &c. — are sometimes met 
with, either embedded in the walls or project- 
ing into the cavity or from the surface. 

Fibroid Degeneration. — More common 
on the right side; substance is firm, leathery; 
cavity retains the form due to distension; 
most frequently associated with hypertrophy; 
it is generally a result of inflammation. 

Patty Deposition must not be con- 
founded with fatty degeneration. The latter 
is a serious affection; the former ('obesity of 
heart ') is not so serious, and is consecutive 
on general obesity; fatty deposition takes place 
on the surface of the heart and between the fas- 
ciculi, the muscular structure being histologi- 
cally unaltered, 

Patty Degeneration is always serious, 
the fat heing deposited within the muscular fas- 
ciculi — it is, in fact, a retrograde metamor- 
phosis of the normal structure, which is thus 
more or less destroyed. The patient may be 
thin, and yet have fatty heart. It is a cause 
of angina pectoris. 

This disease may be— 1. Oeneral; then usu- 
ally only slight. Muscular fibres paler, more 
flabby, break up easier, and leave a greasy 
stain on the knife. 

2. Partial; the degeneration is more ad- 
vanced, but in patches, which cause a mottled 
appearance, the degenerated parts heing yellow 
or huff- colored, soft, Jiabhy, and rotten, with 
tendency to rupture or aneurism. 

Fatty degeneration occurs in alcoholism, some 
forms ^ of pleurisy and pericarditis, poisoning by 
phosphorus (in the latter case all form of muscular 



36 POST-MORTEMS. 



structure may be lost, and its place taken by fat 
globules). 

Pigmentary Degeneration.— Muscular 

structure friable and of a brown color. This 
is a rare disease. 

Myocarditis (Inflammation of the Muscu- 
lar Structure).^MM^Q,\x\dkV fibres dark, soft, 
showing under the microscope at first num- 
erous leucocytes within and around the fasci- 
culi; in a later stage, pus. 

Generally results from pyaemia and infectious dis- 
eases, or from emboli in the coronary arteries. 

Chronic Myocarditis is more common, usu- 
ally as a result of rheumatism; it is often 
clearly traceable to syphilis, and leads to 
fibroid induration. The interior of the ven- 
tricle shows patches of a grey or pearly white 
color. 

In gummaceous myocarditis (tertiary syphilis) 
the majority of the muscuhir fibres are re- 
placed by fibrous tissue, with gummaceous 
tumours disseminated. These tumours are 
sometimes of a firm, yellow, cheeselike con- 
sistence, and may obtain the size of a pigeon's 

'Cardiac Apoplexy.'— This term has 
been given to cases where haemorrhagic spots 
and extravasations of various sizes occur in 
the substance of the muscular tissue. 

Rupture of the 'H.Qd^rt.—Mod frequent 

on the left side, seldom at the apex ; generally 

the result of fatty or fibroid degeneration; 

sometimes caused by severe injury, as a blow 

on the chest. 

Gunshot wounds are not always immediately fatal; 
the patient may live for two or three weeks after. 

Cancer and other tumours are occasion- 
ally met with. 

VALVES. 

Auriculo-ventricular may be changed 
into an inextensible rins;, sometimes funnel- 



ORGANS OF CIRCULATION. 37 

shaped, &c , contracted transversely, adherent 
to the walls, retroverted, &c. Structure may- 
be softer, atrophied, perforated (from ulcera- 
tion, then the orifice is surrounded with vege- 
tations); sometimes contains purulent matter 
or fatty substance; may be calcified, hyper- 
trophied, or granulated (vegetations); aneur- 
ism of the valves; hyematoma, met with in 
young children as small papilla containing 
blood. 

Contraction of the valves is generally caused by 
prolonged inflammation. There is a peculiar ten- 
dency for the valves to become calcified, as the result 
of long-continued disease. 

Aortic. — Adherent to the walls or one 

another, rolled up or thickened; free border, 

rugous, cartilaginous, or cretaceous; covered 

with warty vegetations (fibrinous or other 

deposits beneath the endothelium); pierced 

with small openings (fenestrated). 

Aortic valvular disease is infinitely more dangerous 
than mitral disease. 

Depositions of coagida on the valves may be 
mistaken for 'vegetations;' they may be dis- 
tinguished from them by being easily removed 
with care, leaving the valve whole; coagula 
often form on vegetations. 

AVERAGE SIZE OP THE ORIFICES. 

R. Auriculo-ventricular 

(tricuspid) =4:f inches, or 54*4 lines 
L. Auriculo-ventricular 

(mitral) ='^\h inches, or 44-3 lines 

Pulmonic =3^ ,, 40 

Aortic . . =3| ,. 35-5 „ 

These dimensions vary considerably in dif- 
ferent individuals. 

SHAPE OP THE HEART. 

Globular— the right side larger than the 
left, met with in pulmonary obstruction, as 
emphysema or cirrhosis; also in mitral ob- 
struction, but then the left ventricle is hyper- 
trophied as well. 



38 POST-MORTEMS. 

' Bovine ' Heart— left ventricle much en- 
larged, seen in aortic obstruction. 

General Enlargement does not arise 
from valvular disease, but from obstruction 
in some remote vessels, as those of the kid- 
ney, &c. 

MALFORMATIONS. 

In rare cases there are only two chambers, 
in other cases three; origin of aorta and pul- 
monary artery from left ventricle; transpo- 
sition of vessels; absence of pulmonary artery; 
obliteration or destruction of aorta and per- 
sistence of ductus arteriosus) patency of the 
foramen ovale. 

None of these malformations has been proved to 
be the cause of cyanosis, which is still uncertain, 
though it may be associated with any of them. 

ARTERIES. 

The vessels should generally be slit up (small ones 
by means of a fine pair of scissors) and examined in- 
ternally, aorta sometimes as far as the iliacs. Before 
opening them, take the diameter either by the finger 
or a graduated cone. 

Lesions. — Hypertrophy, atrophy, dilata- 
tion (cylindrical, fusiform, or sacculated) or 
contraction of the aorta; arteritis; black or 
violet stains; atheromatous patches on the 
internal surface of aorta, or floating white 
cartilaginous plates in the arch ; aneurism of 
the aorta, which may burst into the trachea; 
sometimes the horizontal and vertical portions 
of the arch of the aorta are united; clots 
more or less obstructing the tube of any of 
the vessels, &c. 

Clots, when organized, should be carefully followed 
along the course of the vessels; in puerperal fever 
they often extend some distance. 

Narrowing of the Calibre of an artery 
may be congenital or from arteritis, pressure 
of a tumour, thickening of the tunics or car- 
tilaginous changes; it leads to gangrene of 
the part supplied. 



ORGANS OF CIRCULATION. 39 



Narrowing of the calibre of an artery does not 
necessarily lead to gangrene of the part supplied by 
the vessel, unless it be a terminal branch. When the 
trunk of an artery is destroyed, the circulation is 
oftentimes restored through the anastomosing 
branches above and below the seat of injury. 

Arteritis, — {Hare), walls reddened, thick- 
ened, or sometimes thinned and friable, struc- 
ture being pulpy exudation of lymph blocking 
up the vessel (this may be purulent, albumin- 
ous, or fibrinous). Cavity narrowed, full of 
soft clots, &c. General arteritis is unknown. 

Chronic Arteritis or Atheroma. — Frequently 
associated with syphilis and as a result of old 
age. 1st stage, deposition of greyish translu- 
cent material in the intima; 2nd stage, fatty 
or calcareous degeneration. 

Sometimes fatty degeneration produces what is 
called an atheromatous abscess or ulcer. 

Aneurism. — 1. Dissecting, from rupture of 

inner and middle coats, due to atheroma. 

2. Diffuse or general dilatation. 

3. Saccular or true aneurism. Causes: ar- 
teritis, pressure, embolism, laceration. 

4. Varicose, with or without a cyst. 

The contents of aneurisms should be care- 
fully observed; they may be soft clots or 
laminated fibrinous deposits. 

Intercranial Aneurisms. — Cause of convul- 
sions, apoplexy, paralysis, insanity, &c. 

Look for aneurism in all cases of large haemarrhage 
from mouth and nose ; note carefully condition of 
aorta. Arteries may rupture without dilatation, from 
fatty degeneration, atheroma, stenosis, etc. 

YEINS. 

Examined chiefly in cases of phlebitis, spontane- 
ous gangrene, varicose aneurisms ; they should also 
be examined in subjects affected with varicose veins, 
oedema, pulmonary embolism, purulent infection, 
&c. Search for varicosities, and see if they are in- 
flamed or softened ; examine the venous network at 
the upper part of the thigh; open the saphena. No- 
tice the uterine sinuses, isolate the utero-ovarian 
veins with the point of a knife, then open them ; do 
the same with the vascular plexus of the broad liga- 
ments and the ovarian veins. Soft and discoloured 
Phleboliths are sometimes found in the vessels here, 
attached to their walls by a thin pellicle; sometimes 
there is suppuration. 



40 POST-MORTEMS. 

In Phlegmasia Alba Dolens there are 
clots or pus in the iliac or hypogastric veins, 
or in one of the principal trunks of the lower 
limbs. 

Phlebitis, Principal Alterations in.— 
Coagulation of the Blood. — This is often a 
cause, not a sign, of inflammation; there may 
be coagulation without inflammation. These 
Clots are various; wine color, grey or whit- 
ish, fibrinous, adherent to the walls or not; 
resistent or breaking down under pressure; 
containing pus (second period), grumous 
(later) ; pierced by a central canal. 

Walls reddened at first, afterwards white, 
swollen; cavity dilated; the vessel is some- 
times moniliform; adherent to surrounding 
cellular tissue, often with phlegmonous in- 
duration (the vessel then feels like a cord). 

Internal tunic may be red or white (accord- 
ing to degree of inflammation), rough, 
opaque, thickened, softened, friable, ulcera- 
ted, &c. 

Observed in pyaemia, poisoning (by dyes, 
&c.), injuries, &c. 

Thrombi from phlebitis, by forming emboli, are 
often a cause of ' metastatic ' abscess, as in the liver, 
kidneys, lungs, brain, &c. 

Pus in Veins. — Suppurative PJilebitis, from 
an abscess bursting into a vein; in cases of 
pyaemia, caries, bubo, &c. Primary suppura- 
tive phlebitis is rare. 

Adhesive Inflammation.— This may be 
primary, as in old people, or from the pres- 
sure of a tumour, but it is generally due to a 
thrombus. 

Phleboliths are calcareous particles which 
obstruct the veins; they are derived from 
degenerated coagula. 

Thrombosis is of importance. A clot 
ormed before death in situ is a thrombus; 



ORGANS OF CmCULATION. 41 

may be distinguished from post-mortem clots 
by — 1, adhesion to the walls; 2, organization; 
3, decolorisation ; 4, deposition of leucoc3^tes; 
5, stratification. Met with in disease of the 
heart, cholera, leuksemia, Bright's disease; 
from pressure on a vein; varicosity; or en- 
trance of pus from an abscess into a vein 
(rare), &c. 

The thrombus becomes hghter in color, drier, 
firmer, and more adherent, by age. 

Embolism, — Obstruction of a vessel by 
particles of coagulated matter from a distant 
part. Originates from thrombi, ' vegetation ' 
from heart, portions of new growth, para- 
sites, pigment granules, &c., escaping into 
the circulation and being carried to some dis- 
tant part. Produces either necrosis or en- 
gorgement from obstructing the circulation. 

Plugging of the basilar or other artery of the 

brain causes paralysis and red softening of the 

brain; of the pulmonary, asphyxia; of the 

coronary, paralysis of the heart. 

Collateral circulation may be established; if it be 
not, then there is necrosis. The part which has been 
cut off is surrounded with a very characteristic zone 
of intense hyperaemia. 

Hsemorrhagic Infarcts may form from 
impaction of an embolus, escape of blood, and 
formation of a thrombus; often met with in 
the lungs, spleen, and kidneys. They are 
firm, wedge-shaped masses of a dark red 
color. 

LYMPHATICS. 

Inflammation.— Red line and swelling 
along the course of the vessel. This redness 
generally subsides after death. Walls thick- 
ened, opaque, less resistant; cavity dilated, 
may contain clots or even pus; abscesses 
sometimes form along the course of the ves- 
sels. Surrounding cellular tissue infiltrated 
with a sero-albuminous, half-concrete fluid. 



42 POST-MORTEMS. 



It 18 never primary, but always follows some 
inflammation of the surrounding connective 
tissue, as from metritis, abscesses, poisoned 
wounds, &c. 

Chronic affections of the lymphatics are 
found in cancer, tubercle, scrofula, &c. 

Lymphatic Glands, — Morbid changes 
are nearly always secondary. Hj^pertrophied 
in phthisis, secondary and tertiary syphilis, 
typhoid fever, glanders, &c., mostly in the 
axillary, cervical, and thoracic regions; some- 
times soft, sometimes hard (syphilis). Tume- 
fied, red, soft and friable, or suppurated 
{Acute inflammation). Swollen, adherent to 
surrounding tissue, containing a caseous mass 
like raw potato; this sometimes softens and 
becomes like pus, or it may calcify {Tubercu- 
lar degeneration). 

Cancer. — Eare as a primary, but common 
as a secondary, affection. 

Syphilis.— Something like tubercular dis- 
ease, only the glands are not so enlarged. 

Other Changes.— Calcification, melanosis, 
epithelioma, amyloid degeneration, &c. 

Lymphsenoma. — Enlargement of the 

glands from hyperplasia of their elements; 

they ma}^ be soft or hard. When associated 

with anaemia and affections of the liver, 

spleen, &c., it constitutes Hodgkin's disease. 

The glands often retain pigments and poisons in- 
troduced from without. 



V 

RESPIRATORY SYSTEM. 

In penetrating wounds of the thorax 

note first the size , shape and direction of the 
wound in the skin and chest- wall ; second, the 
exact location of the wound; third, the in- 
ternal wound, structures injured; fourth, the 



RESPIRATORY SYSTEM. 43 

general direction of the wound compared with 
the point of entrance; fifth, whether the 
wound is recent or inflicted some days prior to 
death. 

Before removing the Lungs, notice the 
form of the pleural cavity; if encroached on 
by the liver, stomach, &c. ; search for fistu- 
lous openings, especially in pneumothorax. 
If this was suspected before death, run a tro- 
car in before opening the thorax, and notice 
the rush of air . 

The amount of this can easily be measured by 
allowing it to escape into an inverted measure glass 
filled with water and standing in a basin or pail; 
press up the diaphragm to get as much air out as 
possible. 

If there is any fluid in the pleura, state its 
nature, quantity, and appearance. 

It may be measured by means of a glass tube with 
an elastic ball at the end ; by compressing this ball, 
and allowing it to expand, the smallest quantity of 
fluid may easily be removed, and if the tube is grad- 
uated it can be read off at once. 

Examine the mediastinum for cancer, 
haemorrhagic effasion (from bursting of an 
aneurism, &c.), acephalocystic tumours, ossi- 
flc plates, air (as general emphysema of 
infants), abscess of lung opening into the 
pericardium, &c. 

Feel carefully round the walls of the chest 
for fracture of the ribs (and compare the seat 
of these with disease of lung or pleura); look 
for osteophytes (old-standing pleurisies); 
abscesses; tumours (as cancer) in the inter- 
costal spaces, &c. 

Remove the Lungs thus :— Divide the tra- 
chea and oesophagus as high as possible; sep- 
arate all adhesions, drawing the lungs down- 
wards and forwards; then sever their connec- 
tion with the diaphragm. 

If the lungs are adherent to the walls, they must 
not be torn away, but the costal pleura is to be care- 
ully detached with them. 



44 POST-MORTEMS. 

Notice the external shape, appearance, 
extent of hypersemia (post-mortem hypostasia 
will give evidence of the position of the body 
at and after death). Examine the edges, the 
base, and the apex; press with the fingers, in 
order to estimate the consistence, induration, 
elasticity, &c. Attach a blow-pipe to the 
trachea and inflate; see if the whole lung is 
permeable to air; then let the air escape; 
this will give an idea of the elasticity of the 
tissue. Inflation will also detect fistulous and 
other openings between the lung and the 
pleura, &c. 

When the lung is suspected of being per- 
forated, but no opening can be seen, put the 
whole lung under water and inflate; bubbles 
of air will escape from the injured part. Pass 
the long blade of a pair of scissors into a 
bronchus and follow the ramifications of the 
bronchi; this is better than simply incising 
the lung. 

LARYNX, TRACHEA, BRONCHI. 

Mucous Membrane.— Red and swollen, 
with much mucus {la7'i/}igitis, catarrhal, syphi- 
litic, &c.), greyish, thickened with muco-pus 
{chroniclaryngitis); oedematous {o&dema gloiti- 
dis, in children especially, also in Bright's dis- 
ease, &c.) 

(Edema is always less apparent after death than 
during life, and the only evidence of it may be a 
wrinkling of the mucous membrane. 

Suppuration (often secondary to erysipelas, 
&c.); plastic exudation in the larynx or 
trachea (croup, cynanche tracJiealis, diphtheria), 
in the bronchi (plastic bronchitis; this is a 
rare disease; the exudation may take a cast of 
the bifurcations in an arborescent form). 
Yellowish white, opaque and viscous or puru- 
lent mucus (chronic bronchitis); surface vel- 
vety or granular, bluish (a sign of suffocation), 



RESPIRATORY SYSTEM. 45 

reddish, violet, slate-colored (different forms 
of bronchitis); thickened, thinned, softened, 
&c. 

Various Lesions. — Foreign bodies (with 
inflammation) ; ulcerations^ syphilitic — small, 
rounded, yellowish nodules with much fibroid 
formation, chiefly at the edges of the epiglot- 
tis; if severe, there may be a shaggy or floc- 
culent appearance ; tubercular — in early stage 
as small corpuscles, then ulcers which from 
coalescence of small ones become large and 
deep, chiefly near the glottis; typhoid — rare 
in this country, situated at the back of the 
larynx, generally a result of gangrene. 

There may be dilatation, this being either 
general or saccular; thinning; obliteration; 
perforation; or contraction (from pressure 
within or without); ossification of the carti- 
lages (senility). Various tumours, as mucoid, 
fibroid, chondroid, &c. 

Bronchial Glands.— May be red, black, 
tumefied, tuberculous, cretaceous, or cancer- 
ous. 

The Bronchi are opened by means of 
very fine scissors with unequal blades {proncho- 
tome), or by a director introduced into the 
tubes and a blade of an ordinary pair of scis- 
sors, or scalpel passed along it. 

In Dilatation search for the cause ; this is 
generally obstruction from cretaceous or 
scrofulous matter blocking up a bronchus, or 
from condensation of lung tissue; it is often 
met with in asthma. 

Parasites are never met with in the air passages of 
man as a disease; if found, they have been intro- 
duced accidentally since death. 

Bronchitis. — Redness of mucous mem- 
brane, from a bright red to a purple color; 
swelling. Secretion of viscid or purulent 
mucus, this oozes from the tubes on section. 



46 



POST-MORTEMS. 



In infants death may be from sudden effusion, 

causing suffocation. 

Always open the bronchi, and especially examine 
the smf. ler tubes, as these may contain purulent 
matter, &c. 

Chronic BroncMUs. — Mucous membrane 

may be deep red, violet or slate-colored; 

sometimes thickened, at other times thinned 

and reticulated. The bronchi are filled with 

thick mucus or muco-pus; in long-continued 

bronchitis this secretion may be offensive and 

of a dark color. It is often associated with 

emphysema and hypertrophy of the right side 

of the heart. 

PLEURA. 

Color. — Red (costal layer in acute pleurisy), 
citron, opaque (pneumonic layer in acute 
pleurisy), semi-opaque, yellow (chronic pleu- 
risy), greenish (last stage of phthisis). 

Contents. — Clear serum {chronic pleurisy)^ 
may cause carnification and atrophy of lung 
from pressure ; may be ascitic fluid (in general 
dropsy); thin layer of lymph, easily peeled 
off {eardy stage of pleurisy) \ thick layers are 
generally superimposed layers of varying con- 
sistence, sometimes it gets like cartilage {old- 
standing pleurisy)-, abscess — pus contained in a 
sac formed by lymph ; this may burst through 
the chest or into lung; adhesions — from or- 
ganization of lymph ; ossific deposits as true or 
false bone ; layer of fat (rare) ; cancer is always 
secondary, as hard, white, flat, and smooth 
scattered patches; blood — from fractured ribs, 
rupture of aneurism, purpuric state, &c. ; air 
— pneumothorax, from disease mostly, as burst- 
ing of a small abscess in, or injury to the 
lung, often the cause of sudden death; con- 
tents of stomach from perforating ulcer; 
tubercle (rare, always secondary), as miliary 
granulations, which may become confluent 
and cheesy by age. 



RESPIRATORY SYSTEM. 47 



LUNGS. 

Hypertrophy ; this state is often uncertain 
when one lung is wasted or destroyed, its fel- 
low may become considerably hypertrophied ; 
atrophy (from pleurisy, &c.). 

Color. — The normal color is grey when the 
lung is deprived of its blood; in disease it 
may be greenish, bluish, livid, rose red (also 
in infancy), pale ^^ellow; slate color, from 
breathing air loaded with carbon, as coal 
dust; claret color; brown, from particles of 
hsematoidin in passive pulmonary congestion. 

Consistence. — Density and elasticity 
diminished or augmented. 

Condensation {atalectasis, a return to the 
foetal state) is either congenital or arises from 
pressure, or want of power to expand, dis- 
tinguished from hepatisation by the surface 
being depressed and not granular. 

Splenisation — lung substance softened, red- 
dened, serous. 

Hepatisation — red, solid, like liver, granillar 
on section, sinks in water; grey hepatisation, 
or carnification, color paler, more solid. 

Hypermmia — lung solid, brown sometimes, 
in long continued congestion, moister in more 
recent (not to be confounded with post-mor- 
tem hypostasia, which is darker and forms on 
dependent parts). Friable, softened, en- 
gorged; more crepitant than natural, as in 
emphysema. 

Emphysema — may be either interstitial (sur- 
face appears studded with beads) or vesicular 
(projections from surface that on section are 
like a sponge, met with in old-standing bron- 
chitis and phthisis). 

Induration or cirrhosis — from fibroid chan- 
ges, a result of chronic inflammation; fibroid 
induration, with cavities and 'tubercles' 



POST-MORTEMS. 



(sometimes called ' chronic pneumonic phthi- 
sis,' but it is properly chronic pneumonia); 
pigment induration — lung dark, dry, and firm, 
in some cases of heart disease; gangrene — 
lung broken up, fetid, fluid of a dirty green- 
ish color. 
Adherent to diaphragm, ribs, &c. 

Morbid Products. — Miliary granulations; 
cretaceous tubercles; tubercular or syphilitic 
cicatrisations (it is difficult to distinguish 
these from each other); gummata of tertiary 
syphilis are grey, cheesy, irregularly shaped ; 
ulceration, abscess (pysemic, phthisic, inflam- 
matory, &c.), perforations (from ulceration, 
injury, &c.); cavities; mdema — the lung is 
heavier, denser, and somewhat translucent, a 
frothy fluid escapes on section (in dropsy and 
Bright's disease); pigmentation, spurious 
melanosis or miner's phthisis — the lung tissue 
is quite black, either in patches or through- 
out, from deposit of carbon, probably from 
smoke or fine dust; the iung may also be in- 
filtrated with powdered glass (in glass work- 
ers), with metals (as in knife grinders), with 
silica, &c. 

Cancer, medullary (primary rare), epithelio- 
ma (secondary); sarcomata, osteo-sarcomata, 
enchondromata, lymphomata; hydatids (hav- 
ing escaped from the liver through a perfora- 
tion). 

Apoplexy of the Lung. — Hmmorrhagic 
infarction, — Blood is effused in the pulmonary 
parenchyma, coagulated, of a dark color; it 
sometimes produces inflammation. The part 
affected is of a globular or wedge shape, with 
the base towards the surface ^ varying in size 
from a pin's head to an orange, and consisting 
of a cavity bounded by comparatively healthy 
tissue. 



RESPIRATORY SYSTEM. 49 

Endeavour to trace the burst bronchus ; the artery 
leading to the part will be found plugged by an em- 
bolus or a thrombus from an inflamed vein or from 
^vegetations' (clots) detached from the valves of the 
heart. 

Emphysema. — Interstitial or Interiohular 
is rare, most frequently associated with gen- 
eral emphysema; it is also seen in children 
who have died of some long-standing bron- 
chial affection. The lung surface appears 
studded with beadlike bullae. 

This condition is not apparently of very great im- 
portance. 

Vesicular is the most common form. It is due 
to dilatation of the air vesicles. The lung feels 
somewhat doughy on pressure, does not col- 
lapse, and is dry and exsanguine. Bullae, or 
apparent projections of lung substance, are 
seen on the front surface of the lung; on 
section these parts are like a sponge. 

It is mostly associated with chronic bronchitis and 
dilatation of the right side of the heart. 

Phthisis, Lesions in.—Lung changes are 
found most and more advanced in the upper 
part of the organ. 

I. Lungs. Miliary Granulations. — First 
stage, isolated or joined together, grey and 
semi-transparent; 2d stage, yellowish white 
and opaque; 3d stage, 'Tubercles' (caseous 
matter), softened (with or without infiltration 
of the pulmonary parenchyma), suppurated or 
transformed into cretaceous, puriform, or 
greenish yellow, souplike matter (gangrene). 
Cavities (vomicae), more or less large, nearly 
empty, or filled with a white, j^ellow, grey, 
green, purulent, sanious, inodorous, or fetid 
liquid; their walls softened or indurated, 
regular or broken up, or beset with pseudo- 
membranous deposits ; with consecutive pneu- 
monia around them; fistulae, etc. 

II. Pleura. Concomitant Alterations. — 
Adhesions to the lungs by cellular, fibrous, or 



50 POST-MORTEMS. 

cartilaginous bands; pleuro-pulmonary fis- 
tulse. Air passages in general. — Bronchi dila- 
ted either uniformly or limited to small areas. 
Ulcerated by tubercular granulations; bron- 
chioles are sometimes closed and form hard 
cords, traversing the vomicae. 

III. Digestive Organs. — Mouth, pharynx, 
and stomach inflamed; intestinal mucous 
membrane thickened, thinned, softened, or 
injected, covered with granulations (tubercu- 
lar, semi-cartilaginous). Biliary Organs — 
Liver fatty, hypertrophied, punctated v^ith 
red spots; bile pale, fetid. Bronchial and 
Mesenteric Glands, hypertrophied, softened, 
containing tuberculous granulations. Ner- 
vous Centres. — Miliary granulations dissemi- 
nated, or in layers, in the pia mater and en- 
cephalon; also surrounding the vessels, and in 
the choroid plexus. 

PNEUMONIA, Lesions in.— Croup- 
ous or Lobar Pneumonia. I. Stage (^71- 
gorgement). — Colour of the surface of the lung 
is violet, livid, or claret color. Floats on 
v^ater and is permeable to inflation, but it is 
more bulky, the density and weight are a 
little augmented, there is crepitation, but less 
than natural, and the elasticity is diminished, 
the finger can easily be forced into the paren- 
chyma (this distinguishes it from simple 
oedema). Its cut surface yields a liquid which 
may be serous, reddish, muddy, or spumous. 

II. Stage {Hepatisation). — Color of the 
surface of lung is a distinctly pronounced dull 
red, uniform or marbled (from absorption of 
blood or coloring matter). There is aug- 
mentation of volume, it does not float, cannot 
be inflated, and there is loss of crepitation, 
the lung substance is hardened, carnified, of a 
consistence like the liver, or the spleen (spleni- 
sation); it is friable. When cut. — Clean, dry, 



RESPIRATORY SYSTEM. 51 

presenting red, hard, rounded, or flattened 
granulations (these being the plugs in the air 
vesicles). Liquid escaping from the Incisions 
(especially by pressure), is small in quantity, 
red, opaque, thick, and muddy. 

III. Stage {Grey Hepatisation). — Colour of 

the surface is grey or pale yellow; darker in 

old people, in children almost white. 

This last state is generally congenital, and is almost 
always due to syphilis. 

Sinks in water, impermeable to inflation; 

volume either augmented or decreased ; there 

is induration with very great friability, but 

less granular than in the last stage. Liquids 

escaping from Incisions. — Matter resembling 

pus; phlegmonous, reddish, inodorous, or 

fetid pus. Sometimes there is slight pleurisy 

with a layer of lymph. 

IV. Results. — Abscess, with an unbroken 
cavity, or irregular walls; simple or multiple 
(pysemic, phlebitic). Gangrene, either diffuse 
or circumscribed. Color in gangrene, vari- 
ous shades of green, brown, or black; sur- 
rounding parenchyma infiltrated with ill-con- 
ditioned pus. Texture softer and moister. 
Absorption. — Cells become granular and fatty, 
then absorbed or expectorated. This gives a 
purulent appearance to the sputa. 

The lung substance in this state is often so soft as 
to be broken up on removal. 

Y. Concomitant Alterations. — Pleurm 
almost always more or less inflamed. Bron- 
chi full of mucosities or dilated into pouches 
containing a purulent liquid. Bronchial 
Glands swollen, red, softened. Heart with 
fibrinous clots in the cavities (sign of s)ow 
death). Gastro-intestinal Mucous Membrane 
softened. 

There is nearly always some pre-existing chronic 
disease of one or more of the other organs in pneu- 
monia. The absence of chlorides in the urine may 
clear a doubtful case even post mortem. 



52 POST-MORTEMS. 



Catarrhal or Broneho-pneuraonia 

{form of Inflammation of the Lungs in Chil- 
dren). — Inflammation is limited to single 
lobules, or groups of lobules; the lung is 
solidified only in patches; these have a ten- 
dency to become chronic and are then yellow- 
ish, dry, and crumbling, so that there is an 
appearance of spots varying in size from a 
pin's head to a pea, either yellow or puriform ; 
this is very characteristic. 

Often met with as a sequel of measles, especially 
in adults. 

There is a peculiar form of pneumonia 
caused by inhalation of particles of food which 
decompose and cause inflammation or gan- 
grene. This is chiefly met with in the insane, 
and especially in those who have been fed 
artificially. 

Interstitial or Chronic Pneumonia. 
{Cirrhosis), — There is an acute form of inter- 
stitial pneumonia, but it is very rare. Gener- 
ally unilateral. Lung is smaller, parenchyma 
dark grey or yellowish, smooth, dense, firm 
(almost cartilaginous), irregularly mottled 
with black pigment; bronchi dilated. The 
normal tissue is replaced by a dense fibrous 
growth. May lead to ulceration and exten- 
sive excavations, or gangrene. This was for- 
merly termed 'chronic pneumonic phthisis.' 

Generally a sequel of some affection of the bron- 
chi, or pleuritic, phthisic, or syphilitic inflammation 
of the lung. 

Typhoid Pneumonia.— There is hyperse- 
mia, and a spotted appearance of the lung, 
both externally and internally; chiefly at the 
posterior part, where there is also consolida- 
tion. 

Cheesy Pneumonia.— The lung passes 
through the three first stages of pneumonia, 
then the lobules are blocked up by ephithelial 
elements which undergo fatty degeneration 



DIGESTIVE APPARATUS. 53 

or caseatioD. In an acute form this consti- 
tutes the so-called 'galloping consumption.' 

LUNGS IN NEW-BOKN CHILDREN. 

Not Respired. — Lungs like liver, of a uni- 
form colour; surface marked by slight fur- 
rows. 

Respired (or inflated). — Ah cells are a bright 
red colour if fresh and filled with blood; if 
they contain less blood, and are examined 
some time after death, they are of a lighter 
colour. 

Hydrostatic Test,— Q^oi entirely reliable, but 
still valuable). An unrespired lung sinks; 
but if decomposition has set in it may float 
from the contained gases. On the other hand, 
a respired lung may sink from disease; though 
some parts would float. Press the piece of 
lung firmly in a cloth, so as not to injure it; 
if it still sinks it has never been respired or 
inflated. Part of the lung ma}^ have respired. 



VL 
DIGESTIVE APPARATUS. 

MOUTH. 

Malformations, corrosions (poisoning by 
caustics, etc.), injuries, marks, etc. The mu- 
cous membrane is a dark purple colour in 
cases of suffocation, etc. 

InfLammation (stomatitis)— gums swollen 
in nodules, coated with thick tenacious mu- 
cus, papillae prominent. 

In chronic inflammation the gums waste 
and seem hard and polished; ulcerations; 
diphtheritic and croupous exudations. 

AphthouH ulceration due to a fungus (pidium 
albicans). 



54 POST-MORTEMS. 

Small-pox pustules. 

Gangrene {cancrum oris or noma), a foul- 
smelling black patch, which becomes grey 
and sloughs. 

Tumours. — Fibromata, sarcamata, osse- 
ous, myeloid, angiomata, adenomata, papillo- 
mata (' epulis ' and * ranula ' are old, worn-out 
terms), epitheliomata, polypi (local hyper- 
trophy). 

Examine the roof of the mouth for fissures, 
ulcerations, tumours, etc., of the soft and 
hard palate. 

TONGUE. 

Hypertrophy {macroglossis), atrophy. 

Wounds caused by the teeth in spasms or 
convulsions may furnish important evidence 
as to the symptoms preceding death. 

In inflammatioa {glossitis), it is swollen 
with prominent papillae. 

Ulceration is either simple or syphilitic; the 
latter with condylomata or as deep superficial 
ulcers with hard walls. 

Cancer. — Scirrhous is nodulated; epithe- 
lial has ragged, everted edges. 

Hydatids are rare. 

Ranula is a cystic tumour caused by ob- 
struction of Wharton's duct and retention of 
the secretion of the submaxillary gland. 

PHARYNX. 

Inflammation {cynanche tonsillaris, ton- 
sils swollen); suppuration {quinsy). 

The tonsils become permanently enlarged after re- 
peated attacks of inflammation. 

Syptiilis. — Callous, well-defined, excava- 
ted ulcers with a greyish floor (' secondary '). 
Unsymmetrical, deep, more extended, with 
gummatous thickening of the neighboring tis- 
sue (* tertiary.') 

Croup. — Mucous membrane in the early 
stage is inflamed, then effusion of liquor san- 



DIGESTIVE APPARATUS. 55 

guinis takes place, and afterwards a deposit 
of a fibrinous matter, which forms the ' false 
membrane ;' this often extends from the larynx 
to the bifurcation of the trachea. 

Diphtheria is not easily distinguished 
from croup, except by being more severe, 
sometimes causing sloughing, and by being 
deeper seated in the substance of the tissue, 
so that the false membrane cannot be removed. 

(ESOPHAGUS. 

Lesions are not frequent, it may be 
wounded from without or within. 

Dilatation — either partial and sacciform 
or general, sometimes like a second stomach. 

Contraction arises from pressure of 
tumours, cicatrisation of ulcers (syphilitic or 
others), poisoning by caustics or cancerous 
deposit in the walls. 

Inflammation — mucous membrane is 
swollen and granular, with uniform redness 
(rare as an idiopathic affection). 

The mucous membrane is normally a pale grey 
colour. 

Ulceration — generally in the form of clean 
cut, round ulcers sometimes with jagged 
edges; simple or syphilitic (in latter case with 
gummata). 

Perforation — often connected with an- 
eurism of aorta, which bursts into the oesopha- 
gus; sometimes joined to the trachea. 

Tumours. — Cancer — sometimes medulla- 
ry, rarely scirrhous, mostly epithelioma. 

This last appears as a circumscribed growth on 
one side, sometimes of a warty nature. 

Warty growths, cysts, myomata. 

The oesophagus may contain foreign bodies as a 
mass of food, bones, false teeth, etc., which may 
pierce the aorta. 

STOMACH. 

The size of the stomach varies consider- 
ably in health ; the following table is the mean 
of several measurements: 



56 rOST MORTEMS. 



Inches. 

Transverse diameter 9 to lOX ) 

Vertical diameter 4 " 5 VDistended 

Anteroposterior 3 " 4 ) 

Inches. 

Transverse diameter 7 to 8 ) 

Vertical diameter 2^ " 3^ V Empty. 

Antero-posterior J^ " ^ ) 

Before opening i^lace a ligature at each 
end, preventing it slipping off by passing a 
pin through the coats; then inflate; notice the 
state of the walls. 

Put the contents in a bottle, if for medico- 
legal examination, and seal up at once, or put 
up the whole stomach without opening. 

Never open if poison is suspected, Leave opening 
for the chemist. 

Open the stomach along the les3er curva- 
ture, and spread it on a glass or porcelain 
plate for examination, then wash with a fine 
stream of water. 

Appearance of the Coats. -Color.— The, 
mucous membrane at death is pinkish white 
or ash-colored ; about five hours after death it 
becomes rose yellow. A hyperoemic state is 
frequently seen independently of the action 
of corrosive poisons, especiall}^ in heart dis- 
ease; during digestion or alcoholism; bluish 
white, grey, slaty or yellowish, from fatty 
degeneration of the epithelium {chronic gastri- 
tis); reddish brown, puckered {chronic gastri- 
tis, pellagra, etc.); rugae studded with red or 
brown spots in haemorrhagic elfusion and 
yellow fever. 

Mucous membrane ivan^iorva^iCL into detritus 
of a chocolate, black, or yellowish color {poi- 
soning by arsenic, etc.); mammillated (chronic 
gastritis, poisoning by a^mmonia.) 

Thickness and Con^istGn.QQ.~- Atrophy 
— post-mortem thinning must not be con- 
founded with disease. Inflamed — swollen, 
intensely red (rarely seen post mortem), sur- 
face covered with thick mucus. Catarrhal 



DIGESTIVE APPARATUS. 57 

inflammation causes at first a slaty color, with 
swelling and softening; afterwards induration 
and hypertrophy. 

Morbid Productions.— Fungous vege- 
tations. Mucous polypi {sarcomata)', hyper- 
trophy of the villi round the glands, and of 
the glands themselves with hypertrophy of 
the muscular tissue. 

This state is often met with in drunkards. 

Plates or mammillse of a reddish brown or 
slaty grey color (chronie gastritis or catarrhal 
inflammation). Pus or blood injecting the 
mucous membrane in an arborescent form. 
Fibrinous exudation {croupous gastritis) rare, 
met with in croup, typhus, pyaemia, etc. 
Gangrenous patches nd infiltration with can- 
cerous or melanotic matter. Tubercle is ex- 
ceedingly rare. 

Cancer. — Scirrhus is the most frequent 
form of cancer, distinguished from simple 
induration (sarcomata or fibromata) — 1, by 
the nature of the cells and cell loculi; 2, by 
the submucous cellular tissue being increased 
in substance; 3, by affection of the lymphatic 
glands. 

Medullary is occasionally met with in the 
form of bleeding fungous excrescences. 

EpitTielioma only as extension from the 
oesophagus 

Colloid rarely. 

Various Alterations.— Ukers and scars, 
either simple, with perforation, or multiple; 
with adhesion to neighboring organs (cancer). 

HcBmorrliagic Effusion into the mucous mem- 
brane is very common, chiefly on the summit 
of the rugae in the form of clots, which are 
brighter or darker according to age. 

Softening is not so important as was for- 
merly thought, being generally post mortem 
from the action of the gastric juice; if pro- 



58 POST-MORTEMS. 

duced during life it is seen chiefly where 
food is (cardiac extremity and fundus); when 
perforated during life, there are signs of in- 
flammation and gradual thinning round the 
hole (which is as if a piece had been punched 
out). Death after perforation is either from 
haemorrhage or peritonitis. 

Heematemesis may be from an exceedingly small 
perforating ulcer. 

Amyloid degeneration is occasionally met 
with. 

Notice the changes in relation to other 
organs; narrowing of orifices, etc. 

•There may also be distension by gas ; dilatation with 
or without "hypertrophy (chronic or rapid). Atrophy 
and retraction; bilocular stomach, or partial stran- 
gulation ; hernia through the umbilicus or diaphragm. 

Abnormal Contents.— 1. Intoxicating 
liquids; poisons; leaves of plants (as yew 
tree, which are needle-shaped). 

2. Fathologic Liquids — mucus, thick, viscid, 
ropy or yellowish, more or less adherent to 
the mucous membrane; black liquid like soot 
(blood-clots); mixed with food or not; like 
coffee (plague); sanious or fetid (cancer, phos- 
phorus); lumbrici; foreign bodies, as sealing- 
wax, nails, buttons, pipe shanks, etc. Torula 
cerevisiw (yeast plant); aphthae; sarcina ventri- 
culi, etc. 

Corrosive Poisons. — Actioji of bichloride 
of mercury causes a slate color of the mucous 
membrane. 

Arsenic, a yellow color, portions of the 
poison may remain as a white powder. 

Orpiment and Scheele's green leave a green 
stain, etc. 

Mineral Acids. — Greenish, yellow, brown 
or black glutinous secretion, rugae softened; 
ulceration and perforation frequent. 

Sulphuric Acid often bleaches the mucous 
membrane, which then appears as if coated 
with white paint. 



DIGESTIVE APPAKATUS. 59 

Nitric Acid changes the mucous membrane 
to yellow or green; perforation is less fre- 
quent than with sulphuric acid. 

Alkalies produce inflammation, abrasion, 
and ulceration ; and change the mucous mem- 
brane to a dark or tawny pulp; perforation 
rare. 

Oxilic Acid, mucous membrane pale, free 
from rugae, sometimes inflamed; vessels in- 
jected. 

Nitrate of Potash, inflammation and black 
patches. 

Alcohol, deep crimson or dusky red. 

Garholic Acid somewhat tans the mucous 
membrane. 

Post-mortera Softening and Perfora- 
tion. — Thinning, with arborescent black ves- 
sels running over the part alfected; there is 
usually a kind of water-mark limiting where 
the contents have acted on the coats. The 
opening is generally at the cardiac end; the 
liquid effused is chymous, and the organs in 
contact are softened without surrounding 
inflammation; the edges are thin, ragged, 
shreddy. 

Circumstances producing these changes uncertain. 

PERITONEUM. 

Inflation. — Sometimes it is necessary to 
inflate the lesser cavity of the peritoneum; 
this is done by introducing a blow-pipe 
through the foramen of Winslow thus: raise 
the liver, carry the finger from right to left to 
the neck of the gall bladder and follow this up 

Contents.— I. Liquids.— M^ij be trans 
parent or not; limpid; frothy; flocculent 
albumino-fibrous {chronic jperitordiis); of an 
oleaginous consistence; yellow-citron color 
greenish, etc. 

II. Liquids Mixed loith oilier Matters — faecal 



60 POST-MORTEMS. 



stercoraceous {peritonitis by perforation m^ rup- 
ture). 

Bile, following wounds and rupture of the 
gall bladder. 

Urine, from rupture of the bladder. 

Pus, chronic peritonitis, or by bursting of 
an abscess of the liver, uterus, spleen, iliac 
fossae, bladder, etc. 

Blood, liquid or coagulated, mixed with 
serous effusion (haemorrhagic peritonitis, or 
from rupture of an aneurism, etc.). 

Oases, air more or less rich in oxygen, 
carbonic dioxide, or hydrogen sulphide. 

Foreign Bodies. — Pathologic. — Miliary 
tubercles as semi-transparent grey granula- 
tions diffused generally, but more abundant 
on the surface of the diaphragm and spleen. 

Cancerous Tuynors, encephaloid or colloid, 
may spread over the entire suiface. Fibrinous 
bands, joining various parts into one mass. 
Encysted abscess; blood cysts. 

SuperfcBtation may take place — 1, in the 
fallopian tubes; 2, in the ovaries; 3, in the 
walls of the uterus; 4, in the vagina; 5, in the 
peritoneal cavity. 

Hydatids may be loose or encysted. 

Biliary oi* urinary calculi, or intestinal 
worms, may escape through the walls of the 
abdominal organs into the peritoneum. Acci- 
dental — received from without, as projectiles, 
debris of instruments, etc., needles, etc., 
swallowed. 

Chief Alterations. — Mesentery and Peri- 
toneum. — Grey, slaty {chronic phlegmasia), red 
(with injection of mesenteric vessels), brown, 
blackish, bluish (certain forms of chronic peri- 
tonitis), light and whitish; infiltrated with 
serum, pus, blood, etc.; fatty; thickened, 
thinned, covered with plastic exudations; dis- 
seminated miliary granulations {tuberculosis)', 



DIGESTIVE APPARATUS. 01 

charged with black matter {melanosis, but 
probably pigmentary remains of old inflam- 
mation) ; cancerous patches; ecchymosed spots 
{poisoning by phosphorus)-, pus, urine, etc. 
Hernia; shrivelled; cystic tumors; congeni- 
tal deformities. 

The Omenta. — Adhesions to neighboring 
organs, to abdominal walls, etc. ; red, violet, 
wine color (peritonitis from hernia, omentitis)', 
black, tumefied, thickened, infiltrated with 
plastic matters, blood, pus, etc. Gangrene. 
Surface villous or granulated (simple acute 
peritonitis). Hernise. 

Simple Acute "Bevitonitm,— Peritoneum 
may be dry, sticky, humid; injected, of a 
bright red color, especially along the intes- 
tinal folds; softening; plastic exudations 
causing adhesions, etc. 

Liquids effused (especially on the posterior 
walls), white, milky, yellow, green, muddy, 
flocculent, sero-purulent or purulent, mixed 
with bile, faecal matters or blood. 

Try to trace the cause of the inflammation, gener- 
ally it is from disease of some organ covered by the 
membrane. 

Puerperal. — Inflammation chiefly in the 
lesser pelvic cavity or around the uterus and 
its annexes. Tiie peritoneal and sub-perito- 
neal cellular tissue is red and infiltrated with 
pus. Liquids effused are muddy, flocculent, 
sanious, and fetid, nearly ahcays purulent. 
The peculiar odor is very distinctive. 

Search for the cause in the uterus, uterine sinuses, 
etc. ; may be pieces of decomposing membrane or 
placenta. 

Consecutive Peritonitis— following in- 
jury, etc. — redness less vivid. May be local, 
as over syphilitic affections of the liver, uter- 
us, etc., or over inflammations of the stomach, 
herniae, etc. 

Chronic Peritonitis— more often idio- 
pathic than the acute. There are formations 



62 POSTMORTEMS. 



of false membranes (mostly on the surface of 
the liver); the peritoneum is thickened, often 
matted together, greyish, blackish, soft, fri- 
able. Liquids effused are sero-albuminous, 
white, opaque, semi purulent. 

Tubercular Peritonitis.— Not so fre- 
quent as was formerly supposed: it is gen^r- 
ally secondary, but sometimes primary. In 
the form of disseminated miliary tubercles 
which are found mostly under the diaphragm. 
Three forms — 1, with ascites; 2, with semi- 
organized lymphatic effusion; 8, with consid- 
erable adhesions to the intestines, and ulcer- 
ations. 

INTESTINES. 

Notice all abnormal relations and condi- 
tions carefully in situ. 

In cases of injury, or death from hernia, 
open the abdomen first at these parts. Begin 
the extraction with the duodenum ; sometimes 
it is advisL ble to leave the rectum. Tie up 
each end of the intestines, and let them fall, 
as they are removed, into a pail of water. 
When drawing tliem out to examine and open 
them, pass one end under the handle of the 
pail; this disentangles the intestines and lim- 
its the section. 

Some recommend filling the bowel with water 
before opening— this is useful wiiere perforation is 
suspected, as in dysentery, enteric fever, etc. — but it 
is not always well to do this, as it < isarranges the 
contents, and must certainly not be done in cases of 
suspected poisoning, nor where there may be ento- 
zoons, pus, blood, etc. 

The exterior must be first carefully ex- 
amined, and specially diseased parts removed. 

In opening use an enterotome, and do not 
cut along the free edge, as Peyer's patches are 
situated there, but cut along the insertion of 
the mesentery. Take care also not to rub the 
internal surface of the intestines. 

The normal color of the intestinal mu- 



DTGES nVE APPARATUS. 63 

cous membrane is deep red in the jejunum, 
pale rose in the ileum, and dull white in the 
large intestines. 

Examine attentively for all causes of intesti- 
nal obstruction, etc. Thus, obstruction may be 
spasmodic, or from narrowing of the walls, etc. 

Where there is strangulation it is well some- 
times to inject the mesenteric artery, and 
then notice if the fluid penetrates freely into 
the branches above and below the strangu- 
lated part. 

It is important to state the cause of the 
obstruction — 1, foreign bodies; 2, alteration 
of the coats; 3, pressure from without (ovary, 
uterus, glands, etc.); 4, there may be internal 
obstruction, or diaphragmatic, mesenteric 
hernise, etc. 

Mucous Membrane. — Appearance — May 
be thickened, rugous, mammillated, or puffy, 
with hypertrophy of the muscular coat 
{hernia); granular (cholera) thinning, soften- 
ing; ulceration (in acute tuberculization, 
especially the mucous glands); gangrenous 
(malignant pustule, etc.). destroyed, dried up 
(peritonitis from hernia), friable, flabby (gan- 
grene from hernia, etc.), roughened, ecchy- 
mosed (malignant pustule, yellow fever); 
punctated, injected with blood, pus, etc. 
Cicatrices of typhoid fever; beset with small- 
pox pustules (doubtful). 

Color, — May be red (various forms of enter- 
itis, cholera, etc.), livid, slate color, grey, 
yellow (poisoning by ammonia, etc.), black 
(melanosis, yellow fever, pellagra), blackish 
brown (strangulated hernia), dead-leaf color 
(gangrene from hernia). Portions like wash- 
leather (amyloid degeneration), which turn 
brown after washing and the application of 
iodine; they are seen mostly in Peyer's 
patches. 



64 POST-MORTEMS. 



Changes in the Csivity,— Follicles or 
Glands (duodenal or Brunner's, solitary or 
closed, agminate or Peyer's). — Swollen (scar- 
latina, typhoid fever, cholera, erysipelas, 
poisoning by ammonia, etc); orifices dilated; 
ulcerated (typhoid fever, sometimes in 
cholera); tuberculous; obliterated; seat of a 
confluent eruption (intractable diarrhoea). 
ValvuIcB Gomiuentes. — Augmented in volume; 
atrophied ; covered with ecchymosed patches. 

Foreign Bodies.— 1. Developed in the 
Canal. — Hard stercoraceous matter {entero- 
liths)-, ribbon-like concretions of glairy mucus. 

3. Substances Accidentally Swallowed. — Vari- 
ous metallic plates, toy balls, marbles, knives, 
scissors, spoons (especially in jugglers, etc). 

3. Liquids. — Bloody, puriform, deep brown 
(yellow fever, poisoning by phosphorus, etc.), 
bluish green (altered thickened mucus), yel- 
lowish serosity (strangulated hernia), glairy 
mucus (dysentery), white creamy matter 
(cholera), reddish mucus, blood more or less 
coagulated and mixed with excrementitious 
matters; meconium. 

It is important to take note of the appearances of 
the faecal matter, and this should be mixed with 
water in order to examine its composition. 

Lesions of the Walls.— Narrowing (cir 
cular or moniliform), strictures by syphilitic 
ulcerations, intestinal atresia; partial imper- 
meability; intestine terminated in a cul de sac 
or in a cord; dilatation; bends distended with 
gas or liquids; emphysema; pseudo-membran- 
ous pellicles, false membranes; haemorrhage 
and infiltrated blood (enterrhagia; in soften- 
ing and apoplexy of the brain, with embolism 
of the mesenteric arteries, etc.); ulcerations 
of various origins; perforations of a simple 
or multiple character, of a typhoid, dysen- 
teric, tubercular, and cancerous nature, and 
in gangrene from hernia; opening of the in- 



DIGESTIVE APPARATUS. 65 

testine through the abdominal wall ; rupture 
(from accumulation of fa3cal matters, etc.). 
Pustular eruption; polypi and vegetations; 
lymphomata; scirrhus, colloid and medullary 
cancer, either affecting the structure or adher- 
ent to the external face; fatty tumors; hy- 
dated cysts adherent to the intestines; ento- 
zo5ns; diverticula of the intestines; oedema 
of the intestines. 

Invagination is beat shown by a perpen- 
dicular section. Notice the following in order 
from the outside to the inside: 1, the serous 
membrane of invaginating intestine; 2, the 
two mucous membranes in contact; 3, the 
two serous surfaces; 4, the mucous membrane 
of the invagiDated intestine. 

There may be double intussusception by another 
portion of intestine being forced into tlie first invagi- 
nation. 

There is always peritonitis, arising from 
congestion; this causes plastic effusion, tume- 
faction, going on to softening and gangrene. 

Volvulus is a twisting of the bowels, 
most frequent in the sigmoid flexure. 

Hernia. — Femoral, inguinal, umbilical, 

obturator, pudendal, ischiatic(into the notch), 

ventral, vaginal, rectal, diaphragmatic (rare), 

retro-perineal. 

This last is very rare, the intestine is forced down 
behind the inferior mesenteric artery into the meso- 
colon. 

When a strangulated bowel sloughs, it does 
so where it is strictured; if injured in taxis, 
it is at the most prominent part. 

Incarceration.— By the vermiform ap- 
pendix of the caecum, or by passing through 
a hole in the omentum, etc. 

Enteritis.— General (rare). 

Catarrhal — mucous membrane pink, cov- 
ered with semi opaque mucus; in fevers, 
croup, etc. ; chronic catarrhal — surface dark- 
ened. 



66 POST-MOllTEMS. 



Local ioflammations — daodeniiis (after 
burns), ileitis, colitis, typhlitis (inflammation 
of caecum and the appendix), perityphlitis 
(inflammation of the cellular tissue surround- 
ing the caecum). 

These last may arise from foreign bodies in the 
appendix; bur, as Wilks and Moxon observe , hard 
dark concretions may form in this situation from 
chronic di'iease, and resemble date stones, etc. 
Colitis is often mistaken for dysentery. 

Lesions in Typhoid or Enteric Fever. 

— These are mostly situated at the end of the 
ileum, near the ileo-coecal valve, at the free or 
convex edge. 

Glands or Follicles. — (Agminated or 
Peyer's Patches). I. Stage — Softened or Reti- 
culated Patches. — Surface slightly raised; 
glazed, grained, mammillated; mucous mem- 
brane softened, of a brain-like consistence, 
rose red with grey points; submucous cellular 
tissue thickened and depressed. Surrounding 
mucous membrane exceedingly vascular. 

II. Sta,ge — Honeycomb Patches. — Patches 
raised more considerably, harder, with elastic 
resistance; submucous cellular tissue (in the 
whole extent of the patches) yellowish white, 
firm, dry, and brittle or friable, glistening. 
Solitary glan<ls in the neighborhood of the 
caecum are white or red, swollen, thickened 
(rarely) or ulcerated. 

III. Stage — Ulcerations. — Often succeeding, 
on the ninth or thirteenth day, to the softened 
patches, and still more often to the honey- 
comb patches; they are due to necrosis and 
separation of the diseased tissue, a. Form. 
Oval, elliptical, or circular (a large patch pro- 
duces an oval or elliptical, a small gland a 
round ulcer, and partial destruction of the 
tissues produces an irregular shape), h. Size. 
— From a hempseed to a half-crown, c. 
Color. — Red, brownish, slaty grey, or yellow 
(this is peculiarly diagnostic), d. Edges. — 



DIGESTIVE APPARATUS. 67 

Hard, thick, raised, thin, regular or dentated. 
Perforations in consequence of the destruc- 
tion of the mucous membrane and of the 
cellular and muscular coats sometimes occur. 
IV. Stage — Cicatrization, — By the approxima- 
tion and union of the undermined edges with 
the jQoor of the ulcer. The cicatrix is slightly 
depressed, and less vascular than the surround- 
ing mucous membrane. There is no pucker- 
ing or diminution in the calibre of the gut. 

Sometimes the scar is the seat of secondary ulcer- 
ation, which often leads to profuse haemorrhage. 

Mesenteric Ganglions especially in the 
neighborhood of the caecum, a. Color. — 
Delicate rose, deep red, grey, brownish, or 
violet, b. Consistence. — Soft, friable, infil- 
trated with blood or pus. 

Possible Seqaeise.— Alterations of the 
blood, peritonitis, mesenteric adenitis, colitis, 
splenitis, hepatitis, nephritis, laryngeal ulcer- 
ations, meningo-cephalitis, anthracoid erup- 
tion, internal haemorrhage, erysipelas of the 
face, abscess of the iliac fossae, otitis, etc. 

Tubercle.— Generally secondary, seated in 
the submucous tissue, in the form of grey, 
transparent granulations, changing to cheesy 
matter. First affects Peyer^s patches, then 
the solitary glands, afterwards becomes more 
general. The surrounding tissue is hyperae- 
mic, red and swollen. Ulcers form after a 
time, the floors and edges of which are thick- 
ened and hard ; then small nodules form on 
the floors of the ulcers. 

Tubercular differ from Typhoid Ulcers in that 
they extend beyond the confines of tlie follicles 
and patches, gradually implicating the whole 
circumference of the gut; they rarely, if ever, 
heal. If they are oval the long diameter is 
generally transverse to the direction of the 
gut; while typhoid ulcers keep to the shape 
of Peyer*s patches. The wall of the ulcer in 



68 POSTMORTEMS. 

typhoid is abrupt and overhangs the ulcer, 
shown by squirting water on it; in tubercle it 
rises gradually, and tlie floor is thicker than 
the surrounding tissue. Surrounding parts 
are implicated in tubercle. Tubercular cica- 
trisation leads to contraction of the intestines, 
typhoid probably never. 

Dysentery. — Lesions are mostly in the 
large intedines, and chiefly in the descending 
colon and rectum. In the mildest forms the 
chief appearances are a greyish white layer of 
fibrinous matter on the summits of the folds 
of the mucous membrane, which is also swol- 
len, hyperaemic, and softened. Solitary glands 
are enlarged, and look like small ulcers. 

In severer forms the appearances are more 
aggravated; the grey matter extends; submu- 
cous tissue becomes infiltrated, producing 
protuberances (colitis jjolyposa)-, the solitary 
glands slough and cause ulcers; the tube is 
dilated with gas, blood, etc. Ulcers may 
cause perforation and fatal peritonitis. 

In a third degree the mucous membrane is 
partly converted into a slough of a dark red 
or blackish brown or greenish grey color; the 
contents of the tube are a dirty brown or red- 
dish, fetid, flocculent, grumous matter. 

Fourth Stage. — Gangrene; a large portion 
of the mucous membrane is converted into a 
black, dry, roughened mass. 

Cicatrices. — The ulcer may heal by plastic 
exudation, which often forms fibrous bands, 
that encroach on the tube. 

Cholera. — Rigor mortis strong; skin livid, 
face sunken, lungs collapsed and dry though 
dark. The large veins are gorged, and the 
blood generally is like tar. The intestines are 
shrivelled, flabby, and lie in a heap together; 
they are of a rose pink cohr. The internal 
surface is coated with thick mucus and with 



DIGESTIVE APPAKATUS. 60 

a white creamy matter, which diluted causes 

the rice-water evacuations. The solitary 

glands are enlarged. 

Cholera very much resembles poisoning by arsenic 
in its symptoms and post-rnortem appearances. 

Csecum. — It is always important to ex- 
amine this, as foreign bodies often lodge here, 
and invagination of the colon sometimes takes 
place. Inflammation of the csecum {typhlitis 
and perityphlitis) generally arises from accu- 
mulatiou. Mucous membrane at first con- 
gested, then ulcerated; sometimes fistulous 
openings are produced. 

The Vermiform Appendix may be 
inflamed, perforated (frequent cause of peri- 
tonitis); may contain foreign matter, tuber- 
cular deposit, etc. It is sometimes the seat 
of catarrhal inflammation and ulceration. 

Sigmoid Flexure.— Notice the trans- 
formation, sometimes, to the right side in the 
foetus and new born; this is of importance, 
especially in performing colotomy. 

Rectum. — If necessary, fix it on a cork 
plate in order to examine it. 

Mucous Membrane may be thinned, thick- 
ened, hypertrophic!; congested, anaemic, or 
mottled (catarrhal inflammation); infiltrated 
with pus, blood, or cancerous matter; ulcer- 
ated; covered with patches of false membrane 
(croupous inflammation and in dysentery); 
adenomata, as polypoid tumors, in children 
chiefly. 

Various Lesions.— Hernia, vaginal recto- 
cele; various fistulae and fissures; prolapse; 
atrophy of sphincter; chancres and syphilitic 
ulcerations spreading from the vagina; mu- 
cous patches; anal erythema; haemorrhoids 
(these are varicose veins surrounded by loose 
fibrous conoective tissue); condylomata; vege- 
tations; hypertrophy of mucous glands (mu- 



70 POST MORTEMS. 

cous polypi); elephantiasis; cancer, epithe- 
lioma; foreign bodies in the rectum; injuries; 
dilatation. 

Congenital defects, as imperforate anus, 
rectum replaced by a fibrous cord, existence 
of a caudal appendix, &c. May be obstructed 
by tumors, &c., pressing on it. 



VII. 
THE PORTAL SYSTEM. 

LIVEU. 

Abnormal adhesions by plastic exudations 
to stomach, diaphragm, colon, &c. (signs of 
perihepatitis or of hepatic peritonitis, acute 
or chronic). 

Depressed below the limit of the false 
ribs (in hydrothorax, empyoemia, cirrhosis, 
&c.), or elevated above them (ascites, ovarian 
dropsy), with abnormal relations to other 
organs, &c. 

Notice the state of the round ligament; it 

may be pervious and afford communication 

with the systemic circulation. 

May be changed in volume, deformed from stays, 
&c. Congenital malformations are rare, the unusual 
shapes often seen are generally the result of disease. 

Take the dimensions as well as weight of 

the liver. Average weight 50 to 60 oz., 

average measure 10 to 12 inches transversely, 

6 to 7 inches antero-posteriorly, and 3 inches 

at the thickest part. 

The liver may easily be ' washed out ' by injecting 
a stream of water througrh the portal vein (by means 
of a small pipette and india-rubber tube attached to 
the water tap): this tests its permeability, and also 
shows certain lesions better, as haemorrhage into the 
parenchyma, which remains unaffected. 

In making an internal examination of the 

liver, notice if the parenchyma is friable or 

greasy; cut in thin slices and wash, examine 

the structure afterwards, also the washings; 



THE POKTAL SYSTEM. 71 

press the substance and notice the fluid that 
escapes. 

Lesions. — Color. — Uniform dark red or 
brick red, punctated {asphyxia by coal gas); 
yellow with white streaks {tertiary syphilis), 
opaque yellow {fatty infiltration), yellow 
ochre {advanced jaundice), yellow green or 
brown {cirrhosis), livid, earthy grey, slaty, 
bronze; like the flesh of an eel; nutmeggy 
{congestion, disease of the heart, yellow fever, 
&c.), coffee color, mustard color, orange, 
olive (these last in yellow fever). 

Consistence. — Fibrous Structure and Peri- 
toneal Layers. — Softened, adherent to neigh- 
boring parts {perihepatitis), cartilaginous, with 
protuberances wrinkled, &c. 

Sometimes in syphilis (tertiary) the fibrous capsule 
is roughened with miliary or warty products, which 
are of ten very numerous; at other times it is thick- 
ened, hard, callous, adherent to the diaphragm by 
numerous ligamentous cords (perihepatic form of 
syphilis of liver). 

Special lYssue. — May be homogeneous, rug- 
ged or friable, dense, dry, bloodless, indurated, 
fibrous, (edematous, flabby, softened, like 
spleen, &c. 

Lssions. — Congestion (in asphyxia — not to 
be confused with post-mortem congestion); 
inflammation; hypertrophy (first stage of cir- 
rhosis, plague, jaundice, &c; but these are not 
true hypertrophies); atrophy of one lobe or of 
entire liver (second stage of cirrhosis, ad- 
vanced jaundice, &c.). Syphilitic induration 
(lobular cirrhosis); lardaceous degeneration; 
granular induration of drunkards (acinose 
cirrhosis); abscess (pus collected in spots or 
infiltrated), tubercle; cancer — epithelioma 
(secondary), scirrhus, encephaloid, fungoid. 
UcBmx)rrhag6 (in patches ; this is probably due 
to a purpuric state). Adenomata; syphilitic 
gummata; erectile tumors; hydatid and other 
cysts; fluke worms; ulcerations; perforations 



72 POST-MORTEMS. 

(communicating with the peritoneum, pleura, 
&c.); tearing and rupture (spontaneous (?) 
and traumatic); emphysema; displacement, 
&c. 

Small-pox pustules have been said to be met with 
on the liver. 

Congestion. — General or partial, produces 
nutmeg appearances; this is most characteris- 
tic in chronic congestion. Long-continued 
congestion produces structural changes from 
pressure of distended capillaries; the liver 
cells may undergo fuscous degeneration. In 
chronic congestion there is fatty degeneration 
or infiltration. 

Moderate congestions during life do not show 
themselves after death. 

Inflammation. — Acute Hepatitis — little 
known in this country — leads to abscess, 
which is either solitary (tropical) or multiple 
(pysemic); also arises from iajury. 

In Perihepatitis there is thickeniug of the 
capsule, adhesions to other parts, &c. 

Suppuration of the portal veins is some- 
times met with. 

Acute hepatitis and softening may result 
from septicaemia from any cause; notably 
from abortion, criminal or otherwise. 

Chronic Inflammation leads to cirrhosis, 
which is an increase in the connective tissue. 
In Cirrhosis the liver is smaller, paler, puck- 
ered, producing the hobnail condition; the 
cut surface has a mottled, granular appear- 
ance. 

Color, opaque whitish yellow, passing to a 
brown. 

In the early stage of cirrhosis there may be even 
enlargement, and the liver may appear normal mi- 
croscopically, but somewhat firm and dense; on mi- 
croscopical section the interlobular tissue is seen to 
be considerably increased. 

The cause of cirrhosis is chiefly spirit- 
drinking. It is often complicated with other 
liver diseases. A thick coating of membran- 



THh: PORTAL SYSTEM. 73 

ous substance on the surface is a strong evi- 
dence of spirit-driaking. 

Syphilis. — Some say that the liver is the 
most frequent seat of syphilis, as the lungs 
are of tubercle. 

The surface is less glistening, and has the 
color of cafe au kilt; presents many scarlike 
depressions or tumors, v/hich are whitish or 
yellowish and puckered. On section there is 
generally crepitation, and the cut surface is 
clean, cheesy, of a yellow tint (fatty degenera- 
tion), the parts affected are either surrounded 
by a fibrous zone, or striated in white, fibrous 
tracts. Often there are fibrous nodes (gum- 
mala), like those in the lungs, of a pinkish, 
slaty, gray, yellowish, or whitish color. 
They may increase considerably in size; gen- 
erally they range from the size of a hemp-seed 
or a pea to a large plum. 

Cicatrices. — These may form with or with- 
out gummata, and are very chcbracteristic of 
syphilis; underneath them may very often be 
seen small masses of fibrous or cheesy matter; 
the depressions formed by these cicatrices may 
be very deep, so as to make the liver appear 
lobated. 

Sometimes fibrous patches are seen on the 
left lobe, probably from attrition of a con- 
stantly distended stomach. 

In infants minute granulations, something like 
miliary tabercle, are often seen. 

Tabarcle of the liver is very rare, met 
with as collections of small round cells (mi- 
croscopical). 

Yellow Atrophy. — This is rare; the liver 
is very small, soft, lighter in weight, of a dull 
yellow or yellow-red color, like wet rhubarb. 

Microscopically i\iQ cells appear broken up 
and their place taken by granular debris. 

Chemically the liver contains excess of 
leucin and ty rosin. 



74 POST-MORTEMS. 



Brown Atrophy.— SometbiDg like yel- 
low, only the parenchyma is firmer and of a 
deep brown color. 

Fatty Infiltration.— Very frequent; liver 
paler, softer generally, and larger. On cut- 
ting it the knife is coated with oil, and a 
greasy stain is given to paper. Hold a piece 
over a lamp till the water has evaporated; the 
fat will drop out and burn, or can be col- 
lected on paper; by maceration in ether the 
fat is dissolved, and left on evaporation of the 
ether. But the best test is microscopic exam- 
ination; the cells are seen filled with minute 
globules, which after a time coalesce. 

Cause, want of exercise, too much fatty 
food, too little oxygenation of hydrocarbons, 
as in phthisis, i'l habitual spirit-drinkers; after 
long suppuration; in cases of poisoning by 
phosphorus or ammonia; after yellow fever 
(but it is doubtful whether this is really fat; 
probably it is yellow atrophy), &c. 

Lardaceous or Waxy Degeneration. 
— Liver larger, heavier, aad paler than nor- 
mal. Wash the sections and apply solution 
of iodine (iodine 12 grains, iodide of potassium 
24 grains, water 3 oz.); this stains the amyloid 
parts brown, which changes to black or 
violet by the cautious addition of sulphuric 
acid. 

Microscopically, the middle part of the lob- 
ules and the inner coat of the arteries are af- 
fected with structureless deposit. Nothing 
satisfactory is known of this change either 
chemically or indeed clinically. 

Pigmentary Degeneration. — Liver 

dark, greyish brown, sometimes nearly black, 

larger in early stage, atrophied later on. 

Chiefly seen in cases of Intermittent fever, rarely 
in this country. 

Microscopically there is a deposit of round 



THE PORTAL SYfeTE.M. 75 

or angular, blackish granules in the centre of 
the lobules. 

Cancer. — Chiefly encephaloid, of a harder 
structure than usual, forming round tumors 
about the size of a nut; the liver is enlarged. 

Hydatids. — Cysts of various sizes, from a 
pin's head to a child's head. 

GALL BLADDER, 

This may be atrophied, obliterated, or dis- 
tended i)y liquids. Ulcerated (typhoid fever, 
retention of bile, &c.), perforated. May con- 
tain cholesterine or other calculi ; ascarides, 
acephaloc3^sts, distoma, hepaticum, &c. The 
walls may b3 thinned, hypertrophied, or fibro- 
cartilaginous. 

Mucous and Submucous Tissue.— May 

be inflamed (hepatic, or chole- cystitis), swol- 
len, opaque, friable, thinned; ulcerated (with 
black borders, &c.); gangrenous; infiltrated 
with altered liquids, pus, &c. 

Bile. — May be yellow, deep green, brown, 
dirty white, grumous, granular; of a thick- 
ened, pitchy consistence, or fluid. 

Inflammation. — Catarrhal. — Walls in- 
jected and swollen, cavity full of viscid mucus 
or mucus mixed with bile. 

Groupy, same appearance but with solid 
exudations taking the form of the viscus. 

Gall Stones. — Translucent crystalline 
bodies (cholesterine); compound calculi, con- 
sisting of a nucleus surrounded by cholester- 
ine, either in crystals or laminae, sometimes 
alternating with layers of a mixture of choles- 
terine with the coloring matters of the blood 
and bile. 

They are generally deeply colored, and mostly 
consist of cholesterine in combination with lime or 
lime salts. 



7G POST-MOKTEMS. 



PANCREAS. 

This is not examined often, probably be* 
cause its normal structure and uses are so lit- 
tle understood. 

It has been found indurated (tertiary sy- 
philis, disease of the heart, &c.), softened 
(typhoid fever, &c.), hypertrophied either 
from increase of cellular tissue or endothe- 
lium, atrophied (old age, chronic inflamma- 
tion, fatty degeneration), inflamed (rare), infil- 
trated with pus; containing gummata. 

Traumatic lesions are rare. In certain forms of 
dyspepsia there is ulceration. 

Tubsrcle and cancer sometimes affect it. 

Calculi of phosphate of lime, phosphate of 
magnesia, and oxalate of lime are occasionally 
met with. 

SPLEEN. 

This ought especially to be examined in 
fevers, and particularly those of an inter- 
mittent type, also in leucocythsemia, &c. 

Position, notice this — it may be transposed, 
displaced by thehydrothorax, ascites, ovarian 
cyst^, diaphragmatic herniae ; may be adher- 
ent to the diaphragm, stomach, &c. ; sur- 
rounded by fals(3 membranes, clots, &c. 

Supplementary spleens are occasionally met with, 
they are due to division, not multiplication. 

The Capsule may be thickened, either 
generally or in patches, sometimes granulated; 
formation of cartilaginous (fibroid) plates. 

Color. — Instead of the normal dark-bluish 
red it may be violet, with traces of hsemor- 
rhagic softening (chronic splenitis), marbled, 
slaty, black, whitish (amyloid) ; at other times 
it may be yellowish, from pus infiltrating its 
meshes. 

Weight may be increased from 7 oz. (nor- 
mal) to 18, 20, or even 30 lbs. In children 
and adults its proportional weight to entire 



THE PORTAL SYSTEM. 77 

body weight is from 1 to 320 to 1 to 340 ; in 

old age 1 to 700. 

The Size is increased during and after 

digestion. Normal size, 5 in. long, 3 or 4 in. 

broad, and from 1 to 1^ in. thick ; in disease 

it may measure twice or four times this. 

The size is chiefly increased in intermittent fevers, 
also in jaundice, enteric (typhoid), andt\ phus fevers, 
leucocythaemia, rheumatism, plague, scorbutus, ter- 
tiary syphilis, acute glanders, asphyxia, insanity (?), 
tuberculosis— in fact, in all cases Tvhere there are 
much suppuration and alterations of the blood. 

Internal Examination may show haem- 
orrhagic infarcts, infiltration with pus from 
inflammation, or metastatic abscess ; hydrated 
cysts rare. 

Lardaceous or amyloid disease is generally 
coincident with the same disease of other 
organs ; this at first affects the Malpighian 
corpuscles, producing the ' sago spleen.* 

Hsemorrhagic Infarctions are the most 
important lesions and are in the form of 
fibrinous grey nodules. These are often met 
with in disease of the heart, and are probably 
caused by embolism ; they are also sometimes 
associated with softening of the brain, both 
being probably from the same cause, viz., 
vascular obstruction. 

Cysts are occasionally met with, also cry- 
stals of cholesterine, stearine, &c., from retro- 
grade changes in fatty infiltration. 

Leukaemia or Leucocythsemia.— 

spleen enlarged, surface often mottled; 

blood contains an excess of white corpuscles. 

The disease has been described as a cancer of the 
blood. 

Melanaemia {Melanosis). — Deposition of 
black or brown pigment in various tissues of 
the body, as in the mucous and serous mem- 
branes, bone, brain, liver, lungs, &c. 

It is believed to be due to an affection of the spleen. 

Hodgkin's Disease (Lymphadenoma), 
Enlargment of the glands of the body, and 



78 POST MORTEMS. 



especially the spleen, which contains a num- 
ber of yellowish white, opaque, firm, irregular- 
shaped bodies formed of gland structure. 

The liver, kidneys, lungs, stomach, muscles, bon«8, 
and subcutaneous tissue may also become affeotea 
by this glandular hyperplasia. 



VIII. 
URINARY APPARATUS, 

Before removing the kidneys notice their 
relations to other parts, their mobility, dis- 
placement, fresh relations, perinephritic and 
superficial abscesses, the pus of which often 
infiltrates the lumbar muscles, &c. 

Removal. — It is sometimes useful to 
remove the entire urinary apparatus en bloc ; 
in doing so it is simply necessary to remember 
that the ureters run obliquely downwards and 
inwards nearly to the borders of the sacFO- 
iliac symphysis ; from thence they pass down- 
wards, forwards, and inwards to the base of 
the bladder, entering between the muscular 
and mucous coats for nearly an inch, and 
finally opening into the two posterior angles 
of the trigone. 

The right kidney is generally lower thanjthe 
left. 

They are both covered anteriorly with peri- 
toneum ; this has to be cut or torn before 
they can be removed. 

SUPRA-RENAL CAPSULES OR GLANDS. 

These are situated immediately in front of 
the upper end of each kidney ; the right is the 
shape of a cocked hat, the left somewhat semi- 
lunar ; their size varies from IJ to 2 inches 
long, rather less in width, and 2 to 3 lines 
thick ; theyweigh. from one to two drachms. 

The Structure consists externally of a 
cortical layer of a deep yellow color ; inter- 



URINARY APPARATUS. 79 

nally of a medullary substance of a dark 
browD or black color : there is frequently a 
space in the centre from breaking down of 
the tissue, probably from post-mortem decom- 
position. 

The Principal Changes are congestion, 
inflammation and suppuration, haemorrhage 
(apoplexy), fatty degeneration, adenoma, pig- 
mentation, lardaceous or fibroid degeneration, 
containing caseous-like matter often indepen- 
dent of tubercle, cancer, tubercle, serous 
cysts, hydatids. 

In syphilitic subjects the gland is often hypertro- 
phied, and sometimes contains purulent or yellow 
matter, &c. 

Death may sometimes arise from pressure 
of the enlarged supra-renal glands on the solar 
plexus. 

Addison's "Di^QdiSQ.— Capsule enlarged, 
fibrous envelope thickened, adherent to sur- 
rounding parts ; substance hard, nodulated, 
with no distinction between the medullary 
and cortical parts. The new material may be 
either like cartilage, of | grayish color, or 
like ' crude tubercle ' — that is, of a white or 
yellowish opaque appearance — sometimes it 
is mottled, or the tubercular substance occu- 
pies the centre and the pinkish grey matter 
the cortex. 

There is much difference of opinion on this disease. 
Many authors think that bronzing of the skin is due 
to some affection of the sympathetic nerve ; the 
solar plexus and the semilunar ganglia should there- 
fore be examined. 

KIDNEYS. 

The normal size of the kidney is about 
4X2X1 inches, the left somewhat the 
longer and thinner. Weight varies from 4^ 
to 6 oz. in the male and 4 to 5i in the female ; 
the left is the heavier. Proportional weight 
to entire body is about 1 to 240. 

The kidneys are rarely absent ; sometimes 
there is only one by fusion of the two, form- 



80 POST MORTEMS. 



ing the 'horse-shoe kidney '; they are occa- 
sionally misplaced. 

The Ureter of one or both kidneys may 
be double. A specimen in my possession 
presents the following peculiarities, viz. : the 
kidney (right) is divided by a central lobe into 
three distinct lobes: upper, middle and lower; 
the central lobe again divides the pelvis into 
two pelves, with a separate ureter for each, 
both ureters pursuing a similar course to the 
base of the bladder, penetrating the outer coat 
of the bladder at two points one-half inch 
apart, and then uniting about midway through 
the bladder wall into one trunk and opening 
into the bladder by a single orifice. The 
fellow ureter and kidney to this peculiar one 
was normal. — [Ed. 

The kidneys should especially he examined, 

under the following circumstances : — 

In suspected traumatic lesions (rupture, contusion, 
wounds) ; pathologic rupture ; retention of urine ; 
anuria and other disturbances ; uraemia, stricture of 
urethra ; vesical catarrh ; vesical calculi ; gravel or 
gout ; diseases of the heart ; glycosuria (hypertrophy 
and congestion of the kidn-ys) ; rheumatism (rheu- 
matismal nephritis) ; scarlatina (scarlatinal nephri- 
tis) ; hypochondria ; typhoid fever ; putrid infec- 
tion ; alcoholism ; syphilitic cachexia ; oedema of 
new born children ; poisoning by phosphorus, sul- 
phuric acid (tubules contain a grey detritus), and 
lead ; in fat people ; every affection producing al- 
buminuria (long-continued use of diuretics may pro- 
duce this, as cantharides, arsenic, alcohol, &c.) 

EXTERNAL EXAMINATION. 

Notice, before removal, the state of the 
Peri-renal Cellular Tissue ; this may be 
thickened and indurated (perinephritis), or 
even ossiform (chronic nephritis), softened, 
the seat of abscesses, &c. 

Then examine the Renal Capsule, and 
notice its appearance and the facility with 
which it separates from the kidney. Some- 
times there are reticulated markings on the 
surface, haemorrhagic effusions (as in poison- 
ing by phosphorus, &c.), fibrinous plates and 



URINARY APPARATUS. 81 

'milk * patches (rheumatismal nephritis), puru- 
lent pustules, &c. 

Gysts under the capsule are frequently met 
with, which may contain serum, or a gelatin- 
ous fluid, urine or pus. Disseminated white 
patches, with hypertrophy of the cortical layer 
of the kidney (simple chronic nephritis). 

The structure of the capsule may be changed, and 
it is frequently adherent to the kidney (chronic 
Bright's disease). 

The Kidney may be displaced, malformed ; 
atrophied or hypertrophied. Surface. — Ru- 
gous, granular, sometimes with cicatrices in 
chronic interstitial nephritis, and certain 
syphilitic conditions ; in the latter there may 
also be small disseminated gummata (very 
rare), and the envelope is in these cases thick, 
opaque, and difficult to remove. 

INTERNAL EXAMINATION. 

Open the kidney with a long thin knife, by 
cutting from the convex border towards the 
hilum ; it is sometimes useful to make several 
incisions in this way. 

The cortical substance in the normal state is 
generally a little deeper colored than the 
medullary, and in disease this distinction may 
be more or less marked. Sometimes the sub- 
stance is deep colored (venous congestion, as 
in asphyxia, diabetes, &c.;, inflamed (nephri- 
tis), marked with streaks (amyloid degenera- 
tion, rheumatism). 

There may also be pus, either in the form 
of an abscess or diffused. It is sometimes 
dilated with urine, from obstruction of the 
ureter, and in retention of urine, when there 
is generally more or less atrophy of the corti- 
cal structure. It may also be indurated or 
softened ; the seat of amyloid degeneration 
(test with iodine), especially in tertiary syph- 
ilis and where there has been long-standing 
suppuration in some other part of the body. 



82 POST MORTEMS. 

Cancer is generally encephaloid, sometimes 
haematoid. 

Tubercle affects the kidney either in the 
form of miliary granulations or as a hollow 
cavity filled with tubercular matter {renal 
phthisis). Haemorrhagic infarcts are met 
with in cases of heart disease in the form of 
wedge-shaped plugs, as in the spleen. 

Calculi are sometimes found embedded in 
the substance, and are readily detected. 

Deposits of fat may form independently of 
Bright's disease. Numerous cellules are often 
met with containing clear or yellow-colored 
serous fluid, mucus, pus or debris of false 
membranes, or urine. 

Cysts may attain a very large size ; some- 
times they contain hydatids, cysticerci, 
Strongylus gigas a (large round red worm), 
Filaria hominis sanguinis (when present in the 
blood). 

The cortical substance is often studded 
with white granulations, surrounded with a 
brownish red border ; they are about the size 
of a pin's head ; in acute senile nephritis these 
contain pus ; in traumatic nephritis they con- 
tain plastic lymph or decolorised fibrin. In 
some cases pus forms between the pyramids. 
Disseminated crystals of urate of soda are 
often met with. 

Microscopical examinations of the kidney should 
always be made, if possible. 

Changes in Bright's Disease (Kayer). 

I. Stage. — HypercBmia or Congestion. — Swell- 
ing of the cortical substance, and thus increase 
in volume and weight ; punctated appearance 
of cut surface (this will be seen better after 
soaking in water). 

This condition, without the punctated appearance, 
may occur in fevers, as Febrile congestion ; it may 
cause ureemia, but not dropsy. 

II. Stage. — Greater iucrease of volume, but 
there is a combination of anaemia and hyper- 



URINARY APPARATUS. 83 

aemia ; the aspect is marbled and injected in 
an arborescent manner ; pale tint, with yellow 
and red patches. Papillae separated by dis- 
colored fissures. 

III. Stage. — Yellow Degeneration ; {1st form 
of Bright ; Ancemia). — The hypertrophy con- 
tinues. Pale, uniform tint, with injection in 
some parts ; granulations and irregularities 
from deposit of plastic lymph. 

IV. Stage. — The kidneys, still enlarged, are 
pale ; their surface studded with milky, gran- 
ular, star-shaped patches, compared to white, 
creamy clots, and due to a deposit of a fibro- 
albuminous matter. 

V. Stage. — Granular aspect more marked ; 
irregularity of the surface of the kidneys. 

YI. Stage {Brighfs third form). — The kid- 
neys—sometimes smaller than normal — are 
hard, cartilaginous, unequal, mammillated 
with small yellow or purple projections. 

English pathologists do not recognize the above 
stages ; but regard Bright's disease as of two dis- 
tinct forms— 1, acute (tubal or desquamative nephri- 
tis) ; 2, chronic (granular degeneration). 

Acute Bright's Disease (Tubal Nephri- 
tis). — The kidney is in the state as described 
by M. Rayer in the first four stages. 

The capsule readily separates and the surface of 
the kidney is smooth. At an early period of the dis- 
ease the organ is large, dark, and soft (hypersemia) ; 
the blood drips from it on cutting it. Then the cor- 
tex gets paler and patchy, from swelling of the tubal 
epithelium ; the paleness increases until the patches 
get white or yellowish white, from deposition of 
molecular fat in the epithelium ; these fatty elements 
give a creamy appearance to the surface. The fatty 
degeneration increases still more until the whole 
organ is one large white mass of fat, without a parti- 
cle of proper kidney structure to be seen either 
macroscopically or microscopically. 

Chronic Bright's Disease {Interstitial 
Nephritis). — Characterised by the G-ranular 
Kidney. In the early stage the kidney is 
hypersemic and somewhat larger than nor- 
mally ; then atrophy takes place in an irregu- 
lar manner, cysts are formed, and the surface 



84 POST MORTEMS. 



becomes granular and adherent to the capsule, 
which is thickened. The color is often not 
much changed, but the structure is altered ; 
the cortex is thinner, paler, and sometimes 
marbled from fatty deposition. 

Suppurative Nephritis.— Small absces- 
ses form in the substance of the kidney, which 
sometimes coalesce. They arise from Pyelitis 
(inflammation of the pelvis of the kidney), 
spreading from the bladder, or from a renal 
calculus, stricture of the urethra, enlargement 
of the prostate (retention of urine causes 
abscesses), or, most frequently, from pyaemia. 

Lardaeeous Kidney.— Secondary upon 
amyloid degeneration of other organs. The 
kidney is paler and larger, cortex smooth ; 
but atrophy often takes place subsequently, 
and it gets more like the granular state. 

If iodine be applied it causes the Malpighian bodies 
to appear as brown specks, and some of the minute 
arteries as streaks. 

Urinary Passages.— The Tuhuli JJriniferi 
terminate in an expanded part of the kidney, 
called the pelvis ; this is a continuation of 
the ureter. 

The calyces, pelves, and ureters have three 
coats — fibrous, muscular, and mucous. The 
surface internally is of a bluish white color 
normally ; in inflammation (pyelitis) this is 
swollen, injected, and villous. The inflam- 
mation may cause deposits on it of a ' putty- 
like ' material, which fill the calyces, or a 
renal calculus may form. There may also 
be pus or mucopurulent matter mixed with 
urine. The pelves frequently become dilated 
from various causes, as stricture. 

Cancer, tubercle, entozoons (strongylus gigas in 
the ureters, distoma haematobium in the renal ves- 
sels) ; these may be the cause of haematuria and 
albuminuria. 

BLADDER. 

Carefully notice its relations, adhesions, 
external appearances, &c. Inject with water 



URINARY APPARATUS. 85 

in order to observe rupture or fistulae, &c. ; 
be careful to do this before removal, as the 
force required to do so may lacerate it. 
Extract entire, if necessary ; this is not diffi- 
cult, especially if it is inflated first. The 
bladder may he dilated in chronic stricture, 
&c., and also from paralysis, as in fever, 
injuries to brain and spinal cord; the import- 
ance of noticing this dilatation in these cases is 
evident. 

The Vesical Mucous Membrane may be 
roughened, discolored (chronic catarrh or 
cystitis), dark-reddish, bright red, green- 
ish grey, or even bluish black; speckled with 
small ecchymoses, marbled like granite 
(catarrh), slate-colored; cedematous, tumefied 
(chronic cystitis), covered with mucus or 
muco-pus ; mammillated ; the muscular coat 
may be atrophied (in long-standing paralysis 
with frequent micturition), hypertrophied 
(in chronic cystitis and from stricture and 
calculus) ; friable, rugous, indurated ; soft- 
ened (chronic cystitis) ; gangrenous ; ulcer- 
ated, or containing abscesses (acute cystitis). 
There may also be exudation, in round spots 
or striae, of a croupy matter ; tubercle, this is 
nearly always secondary to disease of the 
kidney, and is never met with in the female ; 
cancer is also always secondary, met with as 
scirrhus (rare), encephaloid, and as nodules, 
or villous or cauliflower excrescences (most 
common) ; hydatids, but they may be from 
the kidney. 

Vesico-vaginal, vesico-rectal and other fis- 

tulae (the second may have been from puncture 

for retention) ; communications with the 

uterus, pelvis, perineum, &c. 

The bladder may be injured by the catheter oppo- 
site to the urethral orifice. Prolapse of the bladder 
may occur during parturition. 



86 POST MORTEMS. 



Calculi. 1. Uric Acid. Round or oval, 
smooth in layers, pink or yellow. 

2. Oxalate of Lime. Mulberry-shaped, of a 
dark color. 

3. PTwgphatic. Smooth, white, round or 
oval, crumbling easily. 

4. Cystine (rare). Large, round or oval, 
pale yellow, crystallised, smooth. 

5. Compound Calculi, alternate deposition 
0^ various salts. 



IX. 

THE GENERATIVE ORGANS. 

MALE ORGANS. 

The Testicle and its Envelopes.— 

Notice position of the testicle ; it may not have 
descended into the scrotum. 

Undescended testicles generally contain no sperma- 
ttozoa (Curling) ; therefore examine them minutely, as 
this might have an important medico-legal bearing. 

Envelopes. — Extra-vaginal. — Wounds and 
contusions ; ecchymoses ; extravasation of urine 
in the scrotum and fold of the groin ; phlegmo- 
nous inflammation and abscess ; erysipelatous 
inflammation (intertrigo) ; oedema (hydrocele 
by infiltration) ; parietal haematocele by infil- 
tration or eflPusion ; gangrene ; gummatous tu- 
mors of the scrotum and consecutive ulcerations ; 
subcutaneous fibromata, sarcomata; fatty tu- 
mours, cystoid tumors containing urine; der- 
moid cysts ; foetal inclusions ; elephantiasis , fis- 
tulae and fissures ; hypertrophy (without altera- 
tion of the subcutaneous tissue); epithelioma - 
melanotic cancer. 

Tunica Vaginalis. — Inflammation (acute and 
chronic, shown by thickening, injection, effusion, 
etc.), suppuration ; cysts adherent to tunic, hyd- 
atid cysts; hsematocele (traumatic or spontan- 



THE GENERATIVE ORGANS. 87 

eous ; an encysted hydrocele may be converted 
into one) ; hydrocele, congenital (communicat- 
ing with peritoneum) encysted hydrocele, the 
fluid is sometimes mixed with semen. Osteo- 
cartilaginous tumors ; cancer ; foreign bodies ; 
gas, etc. The internal surface may be reticu- 
lated or vascular (inflammation) ; infiltrated 
with pus, blood, or serous fluid. There may 
also be fibrinous exudations (inflammation), fil- 
amentous adhesions producing a partitioning 
into cells, pseudo-membranous sheaths encyst- 
ing blood, loose bodies (as in joints), etc. 

A hydrocele may be found — 1, investing 
the epididymis ; 2, between the testicular por- 
tion and tunica albuginea; or 3, between the 
reflected portions; diffuse hydrocele (fluid in 
that part between the internal abdominal ring 
and the upper part of the tunica vaginalis). 

Testicles.— Malformations, congenital atro- 
phy (often associated with imbecility), one or 
both absent, there is no absolute record of more 
than two; misplaced, undescended; pathologic 
atrophy, hypertrophy. 

Lesions. — Wounds and contusions; testicular 
hsematocele ; hernia testis. Inflammation {acute 
or chronic orchitis) — testis enlarged, indurated, 
(syphilitic), smooth, general enlargement, 
(scrofulous), nodular (fungous protrusion); atro- 
phied (old age) ; hypertrophied ; abscess (acute 
glanders). 

Tubercular aflfections are mostly in the epididymis 
which then contains miliary granules. 

Tumors. — Fibroma (rare), sarcoma, enchon- 
droma ; encephaloid cancer (colloid and mela- 
notic, very rare) ; epithelioma ; gummata, like 
those found in the liver — yellow, fleshy, and 
surrounded by a fibrous zone ; cystic sarcoma ; 
hydatids ; entozoa ; fatty infiltrations (galacto- 
cele; spermatocele; dermoid cysts containing 
hair, teeth, fat, etc. 



POST MORTEMS. 



Spermatic Cord. — Wounds, contusions; 
funicular hsematocele (infiltration or effusion of 
fluid around the cord, encysted or not) ; abscess 
and inflammation of the cellular tissue sur- 
rounding the cord (funicular orchitis, acute or 
chronic funiculitis) ; hydrocele, diffuse (oedema 
of cord), communicating with the peritoneum, 
or with the tunica vaginalis (hydrocele of sac), 
encysted, etc. ; variocele ; hydatid cysts ; adipose 
or gummatous (syphilitic) tumors; tubercular 
or cancerous degeneration; old hernial sacs 
forming a tumor on the cord; hydrocele of 
the funicular hernial sac ; hernia of the omen- 
tum, of the intestine, etc. 

Vesieulse Seminales and Ejacula- 
tory Ducts. — Ought to be examined in all 
cases of impotence. 

In order to expose them saw through the 
pubes ; the tubes should be opened, and some 
of the fluid contents (mixed or not with a little 
serum or glycerine) placed on a glass slide and 
examined under the microscope. 

They may contain calculi ; may be atrophied ; 
tubercular, inflamed, etc. 

Prostate Gland.— Can be reached by 
cutting down on a sound previously passed into 
the bladder. 

It may be atrophied ; undeveloped ; hyper- 
trophied (in advanced life) ; inflamed (acute 
and chronic), suppurated, ulcerated; contain 
tubercle, cancer or cysts (all these last three 
are very rare) ; concretions very frequent) ; 
fibroid degeneration. 

Penis. — May be imperfectly developed, as 
in cretins, etc.; rudimentary penis; phymosis, 
paraphimosis; elongation of prepuce in those 
who have suffered from calculi ; fissured (when 
very small there is pseudo-hermaphroditism ; 
then look for testicle). 



THE GENERATIVE ORGANS. 89 

Fissure on the upper surface is called epispadias; on 
the lower, hypospadias. 

Wounds and contusions; strangulated by a 
ring or wire. 

Inflammation gives rise to chordee from effu- 
sion into and thickening of the corpora caver- 
nosa or spongiosa ; serous infiltration ; abscess 
and urinary fistulse ; peri-urethral abscesses ; 
excoriations ; erysipelas ; cancer, chiefly epithe- 
lioma; elephantiasis; scabs or exanthematous 
eruptions amongst those who work in chromates. 

Syphilitic Chancres.-— Hend or soft ; the pecu- 
liar characters seen during life are absent after 
death, and only hardness remains; phagedsenic 
(in weak states), with or without buboes. Bal- 
anitis (inflammation of the mucous membrane 
of the glans) ; Posthitis (inflammation of the 
inner surface of the prepuce) ; acne, apthse and 
herpes of the prepuce (vary in size from a pin's 
head to a nut) ; warty vegetations (epithelioma) 
on the inside of the prepuce. 

Elephantiasis Scroti. — A simple hyper- 
trophy of the cellular tissue of a chronic nature. 

Urethra. — In some cases it is necessary to 
examine this throughout ; this may be done by 
sawing through the pubic symphysis, or by 
cutting somewhat as for median lithotomy. It 
may be slit up by scissors (bronchotome) or by 
a knife on a director, along the superior wall, 
and the sides pinned down on a board. Notice 
the liquid contents, as blood, muco-pus (urethri- 
tis), altered spermatic discharge (spermator- 
rhoea), etc. 

The urethra may open into the perineum, 
scrotum or elsewhere ; if it is completely closed 
it is called atresia urethrce; there may be con- 
genital stricture. 

Lesions, — Dilatation is most frequent in the 
membranous part, from obstruction or calculus. 
Laceration, from mechanical injury or calculi. 



90 POST MORTEMS. 

Inflammation (urethritis), sometimes catarrhal, 
but generally gonorrhoeal, acute or chronic; 
mucous membrane swollen, injected and covered 
with a muco-pus; sometimes there is plastic 
exudation, croupous or fibrinous inflammation, 
the tube is then blocked up by casts (rare). 
Stricture is often the result of inflammation, 
either long-continued granular or acute, urethri- 
tis generally situated about 4 to 6J inches from 
the meatus ; may be caused by thickening of 
the walls or from a fold of membrane, or by 
cicatrices from ulcers, etc., also from fungus ex- 
crescences. Tubercle rare ; cancer is secondary 
to growths near. 

FEMALE GENERATIVE ORGANS 

1, Ovaries ; 2, Fallopian tubes ; 3, uterus ; 4, 

vagina; 5, vulvae; 6, mammse. 

In important necroscopies the whole of the female 
genital organs should be removed entire; this is not 
diflacult. It is needless to say that the organs should 
first be examined in situ. 

Removal. — Kaise the uterus ; detach the liga- 
ments carefully, preserving the Fallopian tubes, 
and the broad ligaments as far as the ovaries ; 
separate adhesions and divide the vagina just 
below the neck of the uterus. 

In cases where it is advisable to expose the whole of 
the vagina as well, saw through the pubes on both 
sides close to the obturator foramina, and remove the 
symphisis pubis; in this way the whole of the contents 
of the pelvis will be exposed. 

Pelvis. — Notice irregularities and deformi- 
ties — equable enlargement of the cavity {pelvis 
cequabiliter justo major), equable diminution (p. 
ceq. j. minor) rare ; various distortions. 

The normal dimensions are — 

Antero-posterior (sacro- pubic), diameter 4 inchee. 

Transverse (bi-iliac) - - " 5 to 5}/^ " 
Oblique " 4>^to5 " 

The bones or ligaments may be softened or 
eroded; these parts may be injured during 
labor. Exostoses, either rachitic, scrofulous, or 



THE GENERATIVE ORGANS. 91 

syphilitic ; false or cartilaginous exostoses ; oste- 
osarcomata may sometimes be met with. Lux- 
ations of the hip joint occasionally encroach 
on the cavity. 

Ligaments.— Round.— Lesions are: hy- 
pertrophy and lengthening; shortening and 
adhesion (cause of version and flexion). 

Broad. — May be altered in direction and 
connection. Is sometimes the seat of peri-uter- 
ine hcematocelCj which is generally consequent on 
ovarian haemorrhage or apoplexy, haemorrhage 
of the Fallopian tubes, or of the vessels of the 
broad ligament, rupture of an extra-uterine 
pregnancy, or retrograde migration or reflux of 
menstrual blood, etc. Inflammation and sup- 
puration may attack it. 

Cystic tumors of the broad ligament may be mistaken 
for ovarian cysts; these are frequently due to ecLarge- 
ment of the 'organ of Rosenmiiller' (parovarium), the 
remains of the Wolffian bodies, situated between the 
Fallopian tube and the ovary in the folds of the broad 
ligament. 

Fibrous, encephaloid, tubercular, and other 
tumors of the broad ligament, are sometimes 
met with, cholesteatoma, small cystic tumors 
containing scales of cholesterine, epithelium, 
etc. 

The veins are occasionally varicose or in- 
flamed, as in purulent infection. 

OVARIES. 

These organs should be carefully examined in 
every necroscopy. 

Notice, first of all, their situations and rela- 
tions to the surrounding parts (they may 
descend into the groin or labia). They are sel- 
dom wanting, though occasionally rudimentary ; 
there are never more than two. 

The normal average size of each ovary is about 
1^^ inch in length, | in width, and i thick; 
average weight from 60 to 120 grains. 

They are covered in front by the broad liga- 



92 POST MORTEMS. 



ments, and are connected to the uterus by 
special ligaments. They are of a whitish col- 
or, and the surface is either smooth or uneven. 
External Appearance. — They may be flattened, 
shriveled, globular, covered with filiform cel- 
lular excrescences {villous cancer) ^ pseudo-mem- 
branous flakes, or star-shaped excrescences, etc. 

A smooth ovary is evidence of menstruation not having 
commenced. At the catemenial period there is rupture 
of a Graafian vesicle ; the opening cicatrizes in about 
eight or ten days. 

They may be friable, softened, red, and con- 
gested (ovaritis), slaty or black, oedematous, 
covered with gangrenous patches (septicaemia), 
crepitant, etc. 

Internal Appearance. — The chief points to 
notice are the state of the Graafian follicles and 
the number of the corpora lutea, as these show 
the frequency of menstruation and impregna- 
tion. At the menstrual period the ovary is 
very hyperaemic, and also during pregnancy. 

False Corpora Lutea (after menstruation only) 
are small and angular, seldom present a cicatrix, 
have no cavity, are usually soft, and with only 
a thin layer of yellow matter or none at all. 

D'ue Corpora Lutea are large (often the size 
of a marble or mulberry), round, project from 
the surface of the ovary, have a triangular de- 
pression or cicatrix at their summit, and con- 
tain a small cavity, which becomes stellate 
towards the end of pregnancy ; they are vascu- 
lar, lobulated or puckered, firm and yellow. 

Two corpora lutea are formed when there have been 
twin pregnancies. 

The stroma of the ovary may hypertrophy, 
indurate, or soften. 

In Acute Ovaritis, which is almost al- 
ways puerperal, the organ is swollen, vascular, 
and red or wine-colored ; sometimes it is soft- 
ened, infiltrated with sanguinolent fluid or even 
pus, or converted into a grey and sanious pulpy 



THE GENERATIVE ORGANS. 93 

matter. It may burst and produce fatal peri- 
tonitis. 

Chronic Ovaritis is much more frequent, 
and is characterized by a fibroid degeneration 
and thickening of the capsule or of the whole 
organ. 

Ovarian Cysts are the most frequent affec- 
tions ; these may be either — 1, simple or unilocu- 
lar; 2, tubo-ovarian ; 3, compound or muliilocular ; 
or 4 dermoid. 

Notice the adhesions and relations of the cysts, state 
of the Fallopian tubes (permeable or not), length ol ped- 
icle, etc. They may burst into the peritoneum. 

Contents of the Cysts. — Clear hyaline fluid, 
like water; citron or amber color (recent), 
milky (from fat globules) ; thick, mucilaginous, 
gelatiniform, flocculent, brownish, chocolate 
color (from blood or decomposition). 

The Dermoid or Pilferous Cysts 
contain skin, fatty tissue, hairs, glands, teeth, or 
bone (regular or irregular). 

Cancer of the ovary, either primary or sec- 
ondary, is generally intermediate between scir- 
rhous and medullary; a peculiar form called 
villous cancer is occasionally seen. 

Sarcomata, fibromata, angiomata, cartilaginous, bony, 
and other kinds of tumors are sometimes met with. 

FALLOPIAN TUBES. 

Disease of these is more frequent than is gen- 
erally thought. They may be adherent to the 
uterus or ovary (from chronic inflammation or 
old peritonitis) ; sometimes they are flexed, or 
they may be distended (by foetus, blood, etc.) 

Pass a fine wire through the tubes to see if 
they are permeable, or inflate them from the 
uterine extremity. 

Open them by passing a fine scissors (bron- 
chotome) along them from the fimbriform end. 
The mucous membrane may be red or swollen 
(inflammation — in pelvic cellulitis), or gray 



94 POST MORTEMS. 



and discolored. Contents may be thick, wine- 
like, purulent, or whitish, or mixed with tuber- 
culous or cancerous matters (cylindrical cell- 
ules). 

Obliteration may be a cause of sterility. Fi- 
brinous tumors are occasionally met with in 
the tubes. Rupture sometimes occurs from over- 
distension by the catamenia, by serum, or by 
pus ; it may also be from tubal foetation, and 
then takes place about the third or fourth 
month of pregnancy. Acute inflammation is 
characterised by a swollen, reddened, and vas- 
cular state of the lining membrane, which is 
infiltrated with serum, lymph, or pus. Chronic 
inflammation may lead to fibroid thickening or 
to a large accumulation of pus. 

After impregnation it may be possible to find sperma- 
tozoa in the tubes. 

UTERUS. 

Notice its relations to surrounding parts be- 
fore removing it; cancerous and other adhe- 
sions ; versions and flexions ; loss of substance ; 
swelling of the various glands ; compression of 
the sacral plexus, sciatic nerve, iliac vein, etc. 
Examine also the state of the neighboring 
organs, as the rectum, bladder, etc. 

Absence of the uterus is very rare. If 
thought to be absent, search carefully for it or 
its remains in the recto-vesical pouch, amongst 
the muscles of the perineum, etc. ; rudimentary 
bodies may be found. 

The uterus may be bilocular and horned, or unicorn. 

Size. — This varies considerably, even in 
health ; sometimes the uterus continues unde- 
veloped even in adult life, this arrest of devel- 
opment must be carefully distinguished from 
premature atrophy. 

At puberty it is pear-shaped, weighs 8 to 10 
drachms ; subsequently it is larger, more vascu- 
lar, of softer and darker substance ; during preg- 



THE GENERATIVE ORGANS. 95 

nancy it enlarges immensely. After delivery 
it returns to nearly its normal size, and then 
weighs about two ounces ; the edges of the labia 
are fissured, its cavity is larger, and its muscu- 
lar structure is more apparent than in the vir- 
gin state. In old age it atrophies, becomes 
denser in texture, and the orifices are frequently 
closed. 

Usually six months elapse after delivery before it 
returns to normal size. 

The uterus is opened either by cutting 
it through from one side to the other, or by 
a T incision, the long arm of which opens the 
anterior wall half-way up, and the two shorter 
extend from the two Fallopian tubes to the 
first. 

Lesions. — Walls of the Uterus, — Pale, red, 
hypertrophied or turgescent (inflammation) ; 
black, shrivelled, friable, indurated, cartilagi- 
nous (chronic inflammation) ; ossiform (rare) ; 
flabby and spongy, softened, partially destroyed 
(inflammation) ; ulcerated, infiltrated with pus, 
fetid-sanious fluid (cancer) ; false membranes, 
fungous and polypus growths, gangrenous 

Veins and Sinuses. — Gaping, gorged with 
blood, containing clots, in those who have died 
at the puerperal period ; tilled with a puriform 
liquid (puerperal fever ?), gas (doubtful if ante 
or post mortem). 

Malformation, — Kudimentary, double, heart- 
shaped, bicornous, bifid, divided into partitions, 
unicornous, with occlusion of the orifices. 

Versions — ante-, retro-, latero-. 

Flexions — ante-, retro-, latero-. 

Falling down and prolapse into the vagina or 
vulva, with or without lengthening, with or 
without hypertrophy of the neck. 

Prolapse may be due either to laxity of the ligaments 
or to some change in the vagina. 

Inversion may have occurred during labor 



POST MORTEMS. 



or shortly after, either spontaneously or from 
too strong a traction on the cord, or from the 
presence of tumors. 

Hernise of the uterus. 

Wounds. — Traumatic or surgical (Caesarian 
section); pathologic rupture, perforation; it 
may also be injured by attempts to procure 
abortion. 

Various Lesions. — Inflammation {metritis), 
acute is shown by a swollen, softened, and red- 
dened state ; puerperal ; chronic has two stages 
— 1, infiltrated, hyperaemic ; 2, indurated, anae- 
mic; in endo-metritis or uterine catarrh the 
organ is congested and softened, and the mucous 
membrane red, or purple, or whitish; chronic 
endo-metritis (leucorrhoea) ; parametritis or in- 
flammation of the subperitoneal connective tis- 
sue ; false membranes in the cavity from croup- 
ous inflammation ; bag-like cysts {dysmenorrhoea 
membranacea) ; softening. Accumulation of fluid 
(hydrometra), of blood (haematometra), of pus 
(pyrometra), of air (physometra) ; the obstruc- 
tion in these cases may be either a tumor, cica- 
trix of the neck, or a swelling from chronic 
metritis. Cancer and cancroid (these begin to 
form at the cervix — scirrhus, epithelioma, sar- 
coma) ; ulcers (phagedaenic) ; moles, either 
fleshy, foetal, or hydatiform. Hyatids and other 
foreign bodies. Tumors. — Cystic, fibrocystic 
(myoma), fleshy (sarcoma) ; mucous polypi 
(myoxoma) ; glandular or follicular. The so- 
called fibroid tumors (myomata) are very com- 
mon, and often take the form of polypi. Gan- 
grene. Retention of the placenta. 

Metritis. — The most common form is endo- 
metritis or inflammation of the lining membrane 
or uterine catarrh, and is shown by the swollen, 
injected, and velvety appearance of the mucous 
membrane, which is sometimes detached; the 
surface is coated with a viscid, straw-colored or 



THE GENERATIVE ORGANS. 97 

purulent discharge, which may be mixed with 
blood. 

Metritis, or inflamm'ation of the substance 
proper, is nearly always a result of pregnancy 
or traumatism ; the walls are reddened, softened, 
swollen, and contain much lymph. Sometimes 
suppuration takes place, and the matter may 
burst either into the cavity, or into the bladder, 
rectum, or abdominal cavity ; it may become 
absorbed. The inflammation may, though 
rarely, terminate in gangrene. Chronic metritis 
leads either to softening or induration. 

Cancer. — This is in the form of schirrhus 
chiefly, and is characterized by two stages. 1. 
Hardening ; the surface of the uterus is uneven, 
indented but smooth ; when cut into, the walls 
are of a whitish or greyish substance, of a 
fibroid structure, the meshes containing cancer- 
ous juice ; thin slices are semi-transparent. 2. 
Softening ; this takes place sooner or later, com- 
mencing at the cervix, and irregular ulcerations 
form, which may gradually eat away most of 
the uterus and vagina, sometimes perforating 
the bladder or the peritoneum, or the whole of 
neighboring organs and structures may be 
destroyed. Sometimes large masses of gristly 
substance, of a papillary nature, form in the 
ulcers, resembling a "cauliflower excrescence." 

Lesions of the Os Uteri.— The normal 
appearance of the os varies. It is generally a 
smooth oval slit, but it may sometimes be circu- 
lar or triangular, like a leech-bite. In disease 
it may be redder than normal (inflammation), 
granulated (granular inflammation), unequal 
and intented, friable, indurated (sequel of in- 
flammation) ; prominent and hypertrophied, 
atrophied, narrowed; softened and fungous; 
ulcerated (tubercular, or syphilitic, or simple) . 
cancerous encephaloid, scirrhous, hsematoid, 
alveolar, or colloid cancer) ; epithelioma ; cov- 



POST MORTEMS. 



ered with fleshy protuberances (papilloma or 
cauliflower excrescence — this is not cancer). 

A transverse opening, or os, is not a necessary sign 
of childbirth, as it has been seen in infants. 

Adherent to anterior or posterior walls of 
vagina; lengtheningr of the os, sometimes so 
much as to reach as far as the labia, etc. Show- 
ing products of pregnancy as adhesion of pla- 
centa, etc.; varicose veins, false membranes. 
Syphilitic ulcerations (chancre is rare), gum- 
matous tumors. Narrowing of the internal 
orifice ; occlusion of the os by a pediculated or 
sessile fibrous body, by a plastic plug organized 
during gestation. Rupture of the os is either 
spontaneous or traumatic from injury by instru- 
ments during accouchement, etc. 

Malformations. — Double, bifid, or multiple os ; 
congenital obliteration of orifice ; absence of os ; 
conical os (may prevent conception). 

The Uterus and its appendages should be espec- 
ially examined in the following cases : — Phlegmasia 
alba dolens ; abortion ; extra-uterine pregnancy ; 
purulent infection (pyaemia after labor, etc.); 
affections of the uterine annexes, as inflamma- 
tion of the ovaries, broad ligament, etc. ; ster- 
ility; menstrual irregularities; obstinate con- 
stipation ; uncontrollable vomitings of preg- 
nancy, and other obscure symptoms after con- 
finement. 

During Menstruation the uterus is con- 
gested, enlarged, and softened ; the mucous 
membrane is swollen, reddened, punctuated 
with bloody spots, and covered with menstrual 
fluid, which may be more or less watery. This 
state must not be mistaken for inflammation. 

Appearance of the Uterus after 
Parturition. — The organ is flaccid, softer 
than usual, nine to twelve inches long ; cavity 
may contain much clotted blood, pieces of pla- 
centa, decidua, etc. : generally there is a green- 



THJE GENERATIVE ORGANS. 



ish-red fluid covering the internal surface, and 
a soft, pulpy, raw spot where the placenta was 
attached, with semilunar openings on its sur- 
face. The mucous membrane of the os is gen- 
erally of an orange color after a recent delivery ; 
this is a very characteristic appearance if pres- 
ent. 

The Signs of the uterus having been pregnant 
are : — the organ is larger and the walls are 
thickened, the fundus is longer than the cervix ; 
in the virgin womb these are about equal, w^hile 
in children the neck is the longer ; the sinuses 
and vessels are enlarged, and the os is marked 
irregularly by cicatrices. 

Puerperal Fever. — There is inflamma- 
tion and extreme softness of the uterine walls, 
which may contain pus either in their substance 
or the cavity. The adjacent peritoneum is 
inflamed, and there is pelvic cellulitis. The 
uterine sinuses are often seen gaping, or 
blocked up with puriform matter or thrombi ; 
there is secondary affection of the lymphatics, 
and also of the liver, spleen, kidneys, etc., but, 
unlike general pyaemia, the lungs mostly escape 
Infection. 

VAGINA. 

Mucous Membrane. — Bright red (vaginitis), 
brownish, swollen, cedematous (effects of inflam- 
mation) ; covered with granulations due to fol- 
licular or papillary hypertrophy ; eroded super- 
ficially (effects of vaginitis), ulcerated, gangre- 
nous, etc. Vaginitis is usually gonorrhoeal. 
The liquid covering the mucous membrane 
may be greenish-yellow (vaginitis), sanious, 
diphtheric, fetid, purulent, sanguinolent, or 
mixed with clots. 

Various Lesions. — Vesical, urethral, or rectal 
fistulae; stricture following inflammation, etc.; 
presence of foreign bodies ; su])erficial or deep 
follicular cysts ; polypi, as fibrous, sarcomatous, 



100 POST MORTEMS. 



or myomatous excrescences, pediculated or not ; 
cancer, encephaloid or cancroid. Syphilitic 
ulcerations : inversion of the vagina, in falling 
down of the uterus, and prolapse of the vulva; 
effusion of blood under the walls (vaginal haema- 
tocele). Projection into the vagina of various 
internal tumors, as vaginal herniae, vaginal cys- 
tocele (bladder prolapsing with vagina), rec- 
tocele (rectum prolapsing with vagina); abscess 
in the walls or the peri- vaginal tissues. Fibrous 
hypertrophy, vegetations. Various kinds of 
injury may be met with, as from forceps in 
delivery or instruments used to procure abor- 
tion. Poisons, as mercury or arsenic, may be 
feloniously or accidentally introduced per vagi- 
nam. 

Malformations. — Abnormal opening; congen- 
ital stricture; complete absence; obliteration 
and imperforation {atresia)^ impermeability, 
divided by a more or less complete partition, 
bifidity (with or without double uterus.). 

VULVA, PERITONEUM, ETC. 

Vulva. — May be wounded ; rupture of four- 
chette; tearing of the hymen, of the meatus 
(these injuries may arise either during labor 
from careless use of forceps and other instru- 
ments, or from attempted rape). Swelling from 
effusion of blood (thrombus) or hcematoma vulvae 
and oedema of vulva. Eczema, herpes, erythe- 
ma, erysipelas, etc. Gangrenous inflammation 
{noma of infants) this must not be mistaken for 
venereal disease ; it is of a deep, dusky red col- 
or, and the ulcers are greyish with a most fetid 
discharge ; it generally arises from a constantly 
dirty state of the parts. Abscess and vulvitis 
of little girls (simple, ulcerated, diphtheric, or 
gangrenous) are often met with. 

In examining for suspected rape on a child 
it must be remembered that diseases are fre- 



THE GENERATIVE ORGANS. 101 

quently seen in children which may be easily 
mistaken for gonorrhoea. Eape on young chil- 
dren, which may be without penetration, is 
generally followed by inflammation; then , an 
abundant secretion takes place, at first of a 
sanious mucus, then of muco-pus of a yellowish- 
green color and glutinous consistence. 

Lesions. — Non-syphilitic ulcerations ; follicu- 
lar cysts (from obstruction of the sebaceous 
ducts), met with especially in the neighborhood 
of the urethra ; vulvar folliculitis (inflamma- 
tion of the mucous follicles). Warts {condylo- 
mata), sometimes forming by aggregation caul- 
iflower excrescences; "mucous patches,' V these 
are something of the nature of a wart, and are 
characteristic of syphilis; they appear as rose 
or purple-colored, circular or oval elevations, 
flat and covered with a very offensive ichorous 
secretion; they may coalesse and form liarger 
patches. Cancer, chiefly epithelioma. Fibrous 
and encysted tumors; hypertrophied lichen 
(mycosis). Oxyurides may escape from the 
rectum. Elephantiasis is an hypertrophy of 
the skin, and must not be mistaken for enl&.rge- 
ment from deposition of fat. Obliteration of 
the posterior commissure and separation of the 
labia majores by vaginal or uterine tumors. 
Vesico-labial hernise. 

Clitoris.— May be confounded with the 
labia split in two, absent, or developed in an 
extraordinary manner. Hypertrophy has no 
connection with excessive sexual indulgence. 
The meatus urinarius may be situated on the 
summit of an hypertrophied clitoris which 
might be easily mistaken for a penis. There is 
the case of a woman who was thought tp be a 
man, and married as such ; her real sex, was 
only discovered after death by the presence of 
a uterus. 



102 POST MORTEMS. 

Perineum.— May be thinned and narrowed 
from disease; enlarged; absent (ei her from 
rnpture or as a congenital defect) ; contused, 
wounded (rupture and tearing) from labor, 
attempted rape, etc. Fistulae, excoriations, 
intertrigo, eczema, urinary tubercles ; perineal 
hernia and protusion of the perineum by vari- 
ous internal tumors, as bsematocele, cystocele, 
etc. 

MAMMiE. 

Before proceeding to open these, it is always 
well to make a physical examination first^ in 
order to estimate their hardness, softness, mo- 
bility, etc. ; by pressure milk or pus may escape. 
In order to open them, divide the skin by three 
or four lines radiating from the nipple to the 
circumference, and reflect the triangular pieces 
of skin ; or remove the breast entirely by one 
or two semi-elliptical incisions. Having ex- 
posed the organ, notice the state of the lacteal 
tubes, adhesions to neighboring parts, etc. 

Lesions, — Eczema, syphilitic induration and 
gummata ; abscesseSj these are termed ex^ra-mam- 
mary or superficial when situated between the 
skin and the breast, post or sub-mammary when 
behind the gland, true or intra-mammary when 
the glandular structure itself is afiected. Fis- 
tulae; partial or general hypertrophy (the 
breasts generally enlarge at the menstrual 
period). Tumors — adenoma or formed of gland 
structure; nodulated, elastic or hard (cystic 
sarcoma), these may be mistaken for cancer; 
cartilaginous (enchondroma), rare; fibroma 
(fibrous tumor) ; fatty (lipoma) ; mucous (myx- 
oma), rare; spindle-celled sarcoma (this was 
formerly mistaken for cancer, with which, in 
fact, it may be associated ; milk tumors or 
obstruction of the ducts with natural secretion 
(galactocele) ; cystic tumors (ecchinococus, hyd- 
atid, etc.) ; tubercle, rare ; calcareous deposits. 



THE NERVOUS SYSTEM. 103 



probably from the retention of milk. Atrophy y 
in old age and wasting diseases. 

Cancer. — Most common form is scirrhus, 
which is a hard lobulated tumor at first, with 
affection of the neighboring parts and glands. 
It afterward ulcerates, and the sore has everted, 
raised, and puckered edges, with fetid secretion. 
Medullary cancer — brain-like in appearance — is 
met with in early life. Colloid has been very 
rarely seen. 

Adenoma of the breast (simple glandular 
tumor) is very often with great difficulty dis- 
tinguished from true cancer, especially in the 
early stage of ihe disease. 

In Man diseases of the breast may occasion- 
ally be met with, such as cancer and fibromata. 
In dropsical or fat men the breasts are often 
very large, but they have no gland structure. 
Cases are reported of men having true mam- 
mae which secreted milk, but they are doubtful. 



X. 
THE NERVOUS SYSTEM, 

HEAD. 

For the method of opening the head, see 
Chapter III. Before doing so the Scalp must 
be carefully examined. Notice the color and 
state of the hair. Look for fresh wounds and 
cicatrices, as cuts, bruises, abrasions ; echymoses 
with subcutaneous effusion or sanguineous swell- 
ings ; punctures through the fontanelles or tem- 
poral bones (these may be very minute) Var- 
icose aneurisms, oedema, pneumatocele (from 
communication with the frontal sinuses or mas- 
toid cells), diffuse inflammation of the cellular 
tissue ; erysipelas (see if there is a wound as 
well, and look for evidences of a debauch); pro- 



104 POST MORTEMS. 

trusion of the brain through an opening in the 
skull, from a trephine wound or separation of 
the sutures (encephalocele). 

The head of a new-born child may be injured during 
labor by instruments or pressure, etc., or by a fall, as on 
to the ground accidentally. Sanguineous tumors on the 
heads of new-born children (cephalhsematoma) arise from 
pressure during labor. 

SKULL CAP. 

Fractures. — These must be carefully ex- 
amined, in order to judge the direction, extent, 
nature of the cause, etc. ; where they are indis- 
tinct or doubtful it is well to rub some ink in. 
The bone may be depressed or protruded, or 
radiated from the point of contact, etc. 

Always try to determine from the appearance if the 
injury is from a blow or a fall ; take some of the part 
injured and examine it carefully— microscopically, if 
necessary — it may retain some particles, as dirt, pieces 
of wood, metal, etc., which may afford important evi- 
dence. 

Perforations, as in infanticide, may be very 
small. Exostoses, osteophytes, and periostoses ; 
these may serve to explain some cases of paral- 
ysis; notice carefully their exact situation. 
Premature closure of the fontanelles may be a 
cause of epilepsy, cretinism, etc.; they may 
remain open longer than natural, as in hydro- 
cephalus. Irregular development of the skull ; 
not proportionate to the stature. Malforma- 
tion, as flattening (not traumatic); increase in 
the basal circumference, rotundity of the cra- 
nium (sometimes peculiar to idiotism or epilep- 
sy), general volume increased or decreased 
externally; take the measure by means of a 
pair of calipers. 

Remove the skull cap as directed in Chapter 
III; if there is a fracture, the greatest care 
must be taken in sawing through the bones, and 
it is well, if possible, to first remove the frac- 
tured part entire. Now examine the interior, 
and see if the abnormalities on the outer have 
any corresponding state on the inner surface, 
and also if lesions affect the dura mater as well. 



THE NERVOUS SYSTEM. 105 

In suspected blows examine the side opposite to the 
presumed injury for fracture by contre coup, a^ at the 
base of the skull. 

The inner table of the skull may be exten^ 
sively fractured without any signs of much ex- 
ternal injury. If the blow has been from a light 
weapon sharply applied, the fracture is confined 
to the seat of the injury; if from a large body 
moving slowly, the injury is diffused. 

DURA MATER. 

Carefully examine the external surface' as far 
as it is exposed ; notice the adhesions, transpar- 
ency or opacity, redness, effusion of blood ; then 
judge whether it was produced before or after 
death, and look for corresponding injury to the 
bones and scalp, either near the seat of effusion 
or at some distant part. 

The effused blood may be more or less absorbed, some- 
times only a thin layer of decolorized fibrin remaining. 

The color of the dura mater is often of a rnpre 
or less deep yellow, as in jaundice or yellow 
fever and poisoning by crude carbolic acid. In 
syphilis there is frequently a peculiar yellow- 
ish grumous deposit either in the form of gran- 
ulations or as a pseudo-membrane. In deaths 
from prussic acid, or cyanide of potassium, or 
acute alcoholism, the odor of cyanogen or spirit 
is distinctly perceptible. 

The Pacchionian bodies may be en- 
larged, frequently forcing their way through 
the pia mater ; the nature of this enlargement 
is uncertain; or they may be disseminated and 
must not be mistaken for tubercles^ 

Divide the dura mater either along the edges 
of the sawn bones or across the vertex, or by a 
longitudinal incision a little to one side of the 
longitudinal sinus ; then divide the falx cerebri 
as near the crista galli as possible, and turn the 
membrane aside or back, or remove entirely. 

Lesions of the Dura Mater. — Dis- 
tended with serum (hydrocephalus), with blood. 



106 POST MORTEMS. 

from rupture of a vessel, but see if this is ante 
or post mortem. Depressed, with wasting of 
the brain beneath ; adherent to the skull^ as in 
inflammation from injury or meningitis; in- 
flamed (nearly always from injury); vessels tur- 
gid, showing the mode of death, as poisoning by 
narcotics, apoplexy, etc. ; tubercular and syph- 
ilitic granulations, the former as miliary bodies, 
chiefly at the base, the latter as round, flatteaed, 
hard masses; fungoid growths; epithelial and 
fibrous tumors (notice the exact seat of these); 
dermoid cysts, containing hair, fat, etc. Patches 
of purulent matter, effusion of blood between 
its layers or true bony deposits ; cancerous tu- 
mors; hydatids. Defects are rare. 

Inflammation of the Dura Mater.— 
Acule.—Jn the early stage it is pinky and softer 
than normal ; then there is infiltration and sup- 
puration or effusion of lymph, giving: rise to 
adhesions and new formations. 

Chronic, — Characterized by the formation of 
a false meaibrane on the arachnoid surface, 
which becomes vascularized, and attached more 
or less in patches to the brain substance. 

Many of these false membranes are, no doubt, old 
blood effusions which have become organized. 

Syphilitic Inflammation is shown by a pink or 

red sarcomatous swelling, generally adherent to 

the brain, from one-third to half an inch thick 

and of a roundish flattened form. 

ARACHNOID AND PIA MATER. 

It is generally well to describe these two together, 
especially as modern physiologists regard the 'outer 
layer* of the arachnoid as the endothelium of the dura 
mater, and the 'visceral layer' as belonging to the pia 
mater; the pia is also the more important, as it is the vas- 
cular membrane of the brain. 

Lesions. — The membranes may be dry 
(from undue pressure of the brain), injected 
(acute inflammation), milky (chronic inflam- 
mation); distended with serum (inflammation), 
blood (if coagulated it is a sign of ante-mortem 



THE NERVOUS SYSTEM. 107 

hsemorrhage ; if fluid it may have been effused 
post mortem) or pus (from injury, seldom or 
never from disease). 

In idiopathic inflammation of the arachnoid the eflfu- 
sion has been described as being between it and the pia 
mater; in traumatic inflammation it is between the 
arachnoid and the dura mater. 

The pia may be adherent to the dura mater 
or the brain, either generally or in large or 
small patches from inflammation ; this is often 
seen in general paralysis and other affections of 
the insane, etc. Thickened, softened, infiltrated 
with pus (chiefly along the course of the ves- 
sels), or covered with miliary granulations; 
these latter are nearly always confined to the 
base and the fissures ; if they are seen on the 
vertex, they have spread upwards from the 
base. Tumors of various kinds may be met 
with, as angioma, sarcoma, fibroma, papilloma, 
small epithelial growths, steatoma, hyatid cysts, 
pigmentary deposits, etc. 

Meningitis.— /S'lmpZe. — The first stage of 
active hyperaemia is seldom seen ; there is then 
greatly increased vascularity, more or less dif- 
fuse. Afterwards effusion takes place; this 
may be of various kinds, from a greenish watery 
fluid to an opaque milky deposit ; in rare cases 
pus has been found. 

Tubercular, — This is characterized by the 
deposit of grey, miliary granulations about the 
size of millet seeds, chiefly in the membranes at 
the base of the brain. They are met with most 
abundantly in the fissure of Sylvius, and are 
generally situated in the peri-vascular spaces ; 
they are always associated with inflammation, 
and nearly always with general tuberculosis. 

The disease is well shown by putting the membrane 
in a glass vessel of water over a dark surface, when the 
tubercles appear as white dots. 

Tubercular differs from simple meningitis 

not only by the presence of the tubercles, but 

also by the effusion being chiefly at the base, 



108 POST MORTEMS. 

rarely or never at the vertex. The hemispheres 
of the brain are generally flattened from pres- 
sure ; the ventricles are distended with serum, 
and their walls are softened. 

VESSELS OF THE BRAIN. 

Sinus of the Dura Mater.— May be 
inflamed ; obstructed by clots, especially at the 
^Torcular Herophili;' in cases of poisoning, suf- 
focation, etc., these clots are black and soft; in 
apoplexy, typhus, certain forms of insanity, etc., 
they are fibrinous, adherent, and of a yellow or 
brown color. In some cases of brain-softening, 
meningitis, otitis, etc., a thrombus may be found 
in the sinus. 

In death after erysipelas, pyaemia, etc., these vessels 
are sometimes affected with purulent deposits. 

Arteries. — May be dilated (aneurisms), im- 
permeable from atheroma or other changes or 
obstructed by clots ; they may be rigid, tortu- 
ous, sometimes calcareous. 

Affections of these arteries are met with mostly in old 
people, drunkards, rheumatic subjects, etc., and are fre- 
quently a cause of brain-softening or of apoplexy. 

Air in the Vessels. — This is generally a 
consequence of the manner in which the head 
has been opened, and then of course has no 
pathological significance; it may sometimes be 
due to post-mortem decomposition of the blood. 
Its presence, however, should be stated, and the 
cause for it determined if possible. 

Congestion of the Vessels is mostly a 
sign of the mode of death, and ought not to be 
considered as a cause; it is also often due to the 
position of the body at and after death. Ab- 
sence of congestion of the vessels of the brain 
would suggest the probability that death was 
not from asphyxia. 

Serous Apoplexy. — Sudden efiusion of 
serum has never been known to take place, and 
hence there is no such thing as serous apoplexy. 
Serous eflfusion is generally an accompaniment 



THE NERVOUS SYSTEM. 109 

of brain- wasting, and is not always an inflam- 
matory product. 

URJEMIA. 

In cases of sudden death, with symptoms of 
brain disease, there may be no apparent lesion, 
death being due to ursemic poisoning; then 
look for disease of the kidneys, and test for urea 
in the blood and brain ; it is also important to 
do this in cases of suspected poisoning. 

Test for Urea. — 1 . In the Blood or Sm^um- 
— Acidulate with acetic acid ; evaporate to dry- 
ness over a water bath (small evaporating dish 
or watch glass in a large beaker of boiling wa- 
ter, with a piece of paper or wood so placed as 
to let the steam escape); dissolve the urea in 
boiling alcohol. Then evaporate again to dry- 
ness, add a little water, put it in a freezing mix- 
ture (or place on a piece of lint saturated in 
ether), add a few drops of nitric acid. If there 
is urea the nitrate will form, and can be distin- 
guished by its peculiar form of crystals. 

2. In the Brain. — A good -sized piece of brain 
substance is to be cut up into small pieces, and 
placed in a convenient vessel. Ten ounces of boil- 
ing distilled water are put on them and allowed 
to stand for six or eight hours, the brain being 
frequently broken up with a glass rod during 
this time. The water is then carefully poured 
off into a clean vessel, and the brain is digested 
with another ten ounces of boiling water, al- 
lowed to stand the same length of time, and 
again poured off; this is repeated four times. 
The solutions are all mixed together, filtered, 
and evaporated to dryness. The dry residue 16 
powdered and treated four times exactly as the 
brain was in the first instance, with a smaller 
quantity of water, however. The evaporated 
residue is dried in an oven, and then boiled in 
successive portions of ether. This ethereal ex- 
tract is evaporated to dryness, treated with a 



110 POST MORTEMS. 

little tepid water, filtered, and again evaporated 
to dryness. The residue is to be put on a glass 
slide with a drop of nitric acid, covered with thin 
glass, allowed to stand awhile, and then examined 
under the microscope. Crystals of nitrate of 
urea will show themselves if urea is present 
(from Dr. Todd^s Clinical Lectures^ quoted in 
Aitken^s 'Practice of Medicine^), 

THE BRAIN. 

Notice all that can be seen as to the state of 
this organ while it is in situ; then remove it 
thus : — Having removed the dura mater, draw 
back the anterior lobes, divide the tentorium 
cerebelli from within outwards along the petrous 
bones, and cut the spinal cord as far down the 
canal as possible; then divide the various 
nerves and remove the brain, letting it fall into 
the left hand. Examine the base of the skull 
carefully; there may be fractures, caries, tu- 
mors, etc. Now weigh the whole brain en 
masse ; afterwards divisions of it may be taken 
and weighed separately. The normal brain 
weight is — males, 46 to 58 oz.; females, 41 to 
47 oz. 

Now thoroughly and carefully examine the 
whole surface of the brain ; notice the state of 
vessels (the basilar and meningeal arteries, etc., 
for atheroma, emboli, etc.), adhesion of the 
lobes : look for tubercle or other deposit in the 
fissure of Sylvius. Notice the shape, symmetry, 
and depth of sulci, the flattening or prominence 
of the convolutions, etc.; estimate the consist- 
ence, fluctuation, softening, firmness, etc., of the 
brain substance. Sometimes small patches of 
eflfused blood will be seen at various parts of the 
brain; state exactly their situation, the same 
with tumors. 

It is of extreme importance in connection with the 
localisation of brain function to notice accurately the 
exact seat of pathologic states of the brain. 



THE NERVOUS SYSTEM. Ill 

The under surface of the base of the brain con- 
tains, in order from before backwards — 1, lami- 
nacinerea ; 2, olfactory nerves ; 3, anterior per- 
forated space; 4, optic commissure; 5, tuber 
cinerum; 6, infandibulum and pituitary body ; 
7, corpora albicantia; 8, posterior perforated 
space; 9, crura cerebri, with the third nerves 
{motor oculi) on their inner sides, and the fourth 
nerves (trochlear) on the outer sides. Then 
comes the pons, with the fifth (trifacial) em- 
bedded in it; and behind this is the medulla, 
with the following nerves: — in front is the 
sixtJi {abducens oculi) ; at the side is the seventh, 
a double-nerve {portio dura, or motor of the 
face, and portio mollis, or auditory) ; farther 
back are the three separate nerves forming the 
eighth — the glosso-pharyngeal, the pneumogas- 
tric, and the spinal accessory ; and between the 
pyramidal and olivary bodies is the ninth or 
hypoglossal nerve. 

Remove the arachnoid and pia mater, noting 

any adhesions and their exact situation, as this 

shows localised inflammation; they may be so 

adherent as to drag out the brain substance on 

being stripped off, or they may be separated 

from the brain by effusion. 

Some of the vessels, carefully pulled out with the pia 
mater, may easily be examined microscopically, and 
often furnish important testimony as to disease of the 
brain. 

There are several methods of examin- 
ing the brain substance; the most gen- 
eral is to slice the brain in successive layers 
from the vertex to the base, cutting from within 
outwards, and leaving the slices partially at- 
tached on the outside, so as to preserve the nor- 
mal relations. But a better plan is to separate 
the two hemispheres, and cut from within out- 
wards and slightly downwards, just above the 
upper surface of the corpus callosum. This 
will expose the roof of the lateral ventricles. 



112 POST MORTEMS. 



Before opening the ventricles examine the 
state of the grey and white substance^ the num- 
ber of the puncta sanguinea, both absolutely 
and relatively ; if very numerous and dark this 
may suggest the mode of death (asphyxia, etc.), 
the white part then often appears pink. 

The White Substance may be denser 
than usual, in patches or diffused (sclerosis) j or 
it may be softened, sometimes pulpy. Soften- 
ing {ramollissement) is either red, or yellow^ or 
white: the first is due to inflammation, embol- 
ism, or injury ; the second to fatty degenera- 
tion, and is frequently an evidence of syphilis ; 
white-softening is probably a post-mortem 
change. 

The brain substance is often more watery than 
usual [oedema), and serum runs from it on sec- 
tion ; this is probably a sign of brain atrophy, 
the serum being compensatory. 

The Grey Matter may be paler or darker 
than normal — sometimes almost black (melan- 
aemia) — firmer or softer, or the layers of vary- 
ing consistence; the layers may be more dis- 
tinct than usual ; and the whole grey matter 
may be wider or narrower. 

A good method of examining the grey matter is to 
cut as thin a slice as possible, place it between two 
pieces of glass, and hold it up to the light. 

Cerebral Hemorrhages, forming cyst- 
like cavities in the brain substance, are fre- 
quently met with in various situations, and 
arise either from injury, or disease of the ves- 
sels; in the former case they are generally 
found directly opposite the seat of injury; in 
the latter case they are chiefly in the basal 
ganglia. Their size varies from that of a pin's 
head to a large orange. In cases of cerebral 
hsemorrhage the blood-vessels should be exam- 
ined microscopically, as it is often due to dis- 
ease of the walls of the vessels. The effused 



THE NERVOUS SYSTEM. 113 

blood may after a time be changed into a brown 
clot, or even into a decolorised fibrinous mass. 
Apoplexy is often associated with disease of the 
kidneys. 

Cerebritis is rarely met with as an acute 
affection ; the brain substance is redder and 
softer ; sometimes the white substance is indis- 
tinguishable from the grey. 

Chronic inflammation is generally attended 
with disease of the vessels, and is more local ; 
it often gives rise to sclerosis. 

Pvs may form from inflammation, and is 
met with either diffused through the substance, 
or as an encysted abscess, or as ragged ulcers 
on the surface. These ulcers are frequently 
multiple, of pysemic origin, and generally affect 
the grey matter. 

In old standing abscesses the pus is green. It gener- 
ally is very offensive and has an acid reaction. 

Lateral Ventricles. — In order to open 
the lateral ventricles a small incision is to be 
made in the roof, and the handle of a scal- 
pel passed into the ventricle as a guide for the 
knife for the further division of the roof ; the 
fornix is divided by passing the knife through 
the foramen of Monro and cutting upwards 
and forwards; the brain substance, including 
the roofs of the ventricles and the fornix, are 
now turned back, when the whole of the inte- 
rior will be exposed. 

Notice the state and relations of the various 
parts: the chief of these are — 1, the fifth ven- 
tricle ; 2, velum interpositum ; 3, the choroid 
plexus ; 4, the corpus striatum : 5, the optic 
thalamus; 6, the corpus fimbriatum; 7, the 
hippocampus major and minor; 8, the pineal 
gland ; 9, the corpora quadrigemina ; 10, the 
valve of Vieussens and the fourth ventricle. 

Divide the corpus striatum and the optic 
thalamus so as to expose their internal struct- 



114 POST MORTEMS. 



ure. The remainder of the brain may be 
divided as is thought suitable; perhaps the 
better way is to cut it as much as possible in 
the direction of the fibres, that is, perpendicu- 
lar to the surface. 

The Ventricles in acute hydrocephalus and 
tubercular meningitis are distended with fluid, 
which is often turbid, and the walls of the ven- 
tricles are sometimes softened. The efibsion 
may cause atrophy of the hemispheres. Fre- 
quently the epithelium lining the cavities is 
granular, like sand ; this is considered a sign 
of chronic inflammation. Sometimes there are 
granulations which may be as large as hemp 
seeds. 

The ventricles are occasionally found full of blood; 
In this case the ruptured vessel should be sought for. 

Various tumors are also met with, as warty 
growths, carcinomata, earthy concretions, hy- 
datids, lipomata, enchondromata, etc. 

The Choroid Plexus is of a venous na- 
ture, and probably assists in regulating the 
central circulation ; it is often the seat of vari- 
ous lesions. It may be varicose, tumefied by 
serous eff'usion; the seat of hydatids, erectile 
(angioma), osseous, encephaloid, and other 
tumors; sometimes peculiar hard yellowish 
bodies are found in it of a concentric structure, 
varyiag from a microscopic size to that of a 
small pea or nut. They have been called cor- 
pora amylacea by Virchow, and concentric cor- 
puscles by H. Jones. Some give a brown, some- 
times bluish, tint with iodine ; others, however, 
do not show this reaction. Cysts, cystoid for- 
mations, and fatty tumors are also occasionally 
met with. 

The Fornix is very frequently softened: 
this may be from post-mortem change or dis- 
ease ; the latter must not be too hastily assumed. 

Tumors. — The most common form of tu- 



THE NERVOUS SYSTEM. 115 

mors met with in the brain are the gliomatay 
which are composed of a soft, finelv granular 
material ; they are generally multiple and 
extremely vascular. 

Psammona is a tumor composed of lime saltSj 
and is of a sandy nature; Cholestama is of a 
pearly lustre, consisting of closely set, glisten- 
ing scales of cholestearin, Hyatid cysts often 
attain a large size, and- consist of a bag con- 
taining layers of a gelatinous membrane, on 
which appear a number of small white dots, 
presenting under the microscope the heads and 
hooklets of the echinococcus. 

To preserve the brain for microscopic 
section put it in spirit, colored brown with tinct- 
ure iodine, for four to six days, adding iodine 
occasionally; then keep in Miiller's fluid till 
hard. 



In studying the morbid anatomy of the brain 
it is useful and important to have a chart of 
the convolutions at hand for reference; in the 
mortuary there should be a cast of the brain, 
with the convolutions marked and named. 

The pathology as well as the physiology of 
the brain is still in a very unsatisfactory state, 
and one can only use general terms in describ- 
ing the lesions that are met with. 

It is of course unnecessary to say that affections of 
one side of the brain show themselves on the other 
side of the body. 

Injuries of the brain are always serious, but it 
must be remembered that even very severe 
injuries are not necessarily fatal. A case has 
been noticed where some brain matter escaped 
from the external meatus after fracture at the 
base of the skull, and recovery took place. For 
some^ years an editor of a paper in one of the 
Channel islands performed his duties with a 
bullet in his brain, and at his death one hemi- 



116 POST MORTEMS. 

sphere was found to be completely destroyed. 
Injuries to the basal ganglia are more serious 
than affections of the vertex. 

Cases are on record where a small crow-bar and gas 
pipe have been driven through the head, yet the patient 
lived; pistol and rifle balls have passed through the 
head, the patient living. 

The Brain in Insanity.— Every possi- 
ble lesion has been observed in insanity, but 
none as yet has been found to distinguish it as 
a peculiar affection ; all those lesions that have 
been described as having been met with are 
also seen in health, or apparent health; but 
then, as Dr. Moxon observes, most people are 
suspected by their intimate friends of having 
some mental flaw. It is possible that, as the 
study of insanity becomes more exact and the 
localization of brain-function more definite, 
special lesions may be discovered. But it is 
probable, however, that we may have to look 
to other organs, especially those influencing 
the state of the blood, for the causes of insan- 
ity; and it is not at all unlikely that as the 
sympathetic nerve exercises a great influence 
on mental processes, so some affection of this 
will be found to be a potent factor in insanity. 

SPINAL CORD. 

In cases of locomotor ataxy, progressive muscular 
paralysis or atrophy, sclerosis, etc.. the whole extent of 
the spinal canal has to be opened; this is a diflBcult 
and tedious process. 

In order to remove this for examination the 
subject has to be laid on its face, an incision 
made in the median line, and the skin and sub- 
cutaneous tissue reflected. The muscles, fat, 
and tissue in the vertebral grooves have to be 
dissected out, so as to expose the spinal lami- 
nae ; these have then to be broken with a chisel, 
or sawn through either with an ordinary or 
with a special saw {rachitome)^ and the spinous 
processes of the vertebrae removed. The cord 



THE NERVOUS SYSTEM. 117 

will now be seen lying in the vertebral canal, 
covered hj the dura mater, etc., which is not 
to be opened, but removed with the cord by 
division of the various spinal nerves. In ex- 
amining it to state its consistence, etc., remove 
the membranes jSrst, as a soft, swollen cord 
may seem hard in its resisting membranous 
covering. 

Lesions of the Spine.— Curvature.— - 
Either angular (kyphosis), from disease of the 
bodies of tne vertebrae; lateral {skoliods), the 
cause of which is obscure ; or forwards [lordosis). 

Fracture of the Spine.— When above 
the third cervical^ death is instantaneous ; in 
sudden death of children always look for dislo- 
cation or fracture of the odontoid process, and 
in other cases of sudden death from severe 
injuries a fracture in this part may pass unno- 
ticed unless carefully sought for. 

When fracture is high in the backy but below 
the third cervical, there is palsy of the arms, 
difficulty of breathing, and paralysis of the 
bladder and lower limbs ; the patient may live 
for two or three days, when death arises from 
some affection of the respiration. 

When the injury is in the dorsal region^ 
there is paralysis of the bladder and lower 
extremities; death is then generally due to 
pyaemia or uraemia from retention of urine, and 
may not take place for some weeks. 

Cancer affecting the bodies of the vertebrae 
has the remarkable effect of considerably short- 
ening the stature of the individual. 

Lesions of the Dura Mater.— The 

spinal dura mater is only an investing mem- 
brane, and not a periosteum, as is the cerebral 
dura mater, and therefore not so liable to dis- 
ease. It may be thickened, inflamed (acutely 
rare); seat of spina bifida or abscess (from 



118 POST MORTEMS. 



injury, psoas abscess, bed sores, scrofulous dis- 
ease of vertebrae, etc); may contain morbid 
growths, as cancer, fatty tumor, etc. 

Arachnoid and Pia Mater Lesions. 

— Inflammation {spinal meningitis), a cause of 
convulsions in children, with eflusion of lymph 
or pus (this eflfusion gives an appearance of 
irregularity to the cord); haemorrhage (spinal 
apoplexy); tumors, bony plates (these are very 
common and have no particular importance; 
they might, however, be a cause of tetanus or 
convulsions, tubercle, etc. ; tubercular inflam- 
mation renders the membranes of the cord 
opaque from deposit). 

The Cord. — Atrophy, hypertrophy; hy- 
persemia (but this may be post-mortem hypos- 
tasia, from position of the body); inflammation 
{myelitis — rare) produces red, yellow, or white 
softening; sclerosis (general or local), from 
chronic inflammation. Tumors (cancer, tuber- 
cle, etc.); cysticerci, hydatids (rare). 

Hydrophobia and Chorea, — No defi- 
nite morbid appearance. 

Tetanus. — Generally the appearances are 
only microscopic, and then unsatisfactory ; there 
may be hyperaemia, enlargement of the central 
canal, proliferation of epithelial elements and 
leucocytes, etc. 

Sclerosis. — Cord looks like white of egg, 
of a grey color ; this is due to loss of the white 
sheath of the nerves. Two forms^ one as dis- 
seminated granular masses, the other extending 
ribbon-like through the tissue. 

Locomotor Ataxy. — Induration and dis- 
integration of the posterior columns of the 
cord, etc. 

Signs of Concussion {as after railway 
accident). — Haemorrhage in the dura mater, 
injury to the ligaments and cord itself; inflam- 



ORGANS OF SPECIAL SENSE. 119 

mation, suppuration ; after a time, softening or 
sclerosis. 

NERVES. 

Atrophied ( after injur/, etc., or lesion of 
nerve-centre); hypertrophied ; inflamed (effu- 
sion into the sheath, etc.); neuroma — two kinds, 
one true nerve increase, the other a tumor 
(fibroma, myxoma, etc.) pressing on the nerve ; 
cancer (rare). 

Gliomata are tumors which often spring from 
the retina, especially in children. 

Skin diseases are sometimes associated with 
some affection of the sympathetic or cutaneous 
nerves. 



XL 

ORGANS OF SPECIAL SENSE, 

The most important changes in these are 
noticed in surgical works ; therefore only a few 
need be given here. 

EYE. 

To remove the eyeball and expose the orbit and con- 
tents, carefully break away the orbital plate. 

Eyelids. — Hordeolum (stye), ophthalmia 
tarsi, syphilitic ulcers; trichiasis— eyelashes 
growing inwards ; entropion— eyelids turning 
inwards ; ectropion — eyelids turning outwards ; 
ankyloblepharon — union of the lids to the 
globe. 

Tumors. — Naevi, hydatid cysts, tarsal tumor 
(enlarged Meibomian glands). 

Conjunctiva. — Inflammation ^— catarrhal, 
chronic, purulent, goQorrhoeal, scrofulous (with 
phlyctenulcej or small opaque pimples, at the 
margin of the cornea), granular (membrane 
roughened), pterygium (thick, red, elevated, 
triangular fleshy formation). 

Tumors. — Warts, enchondromata, fibromata, 
polypi, etc. 



120 POST MORTEMS. 



Cornea. — Inflammation (keratitis) — syphi- 
litic (like ground glass), strumous with nodular 
elevations). 

Ulcers. — Leucoma, opaque cicatrix; onyx, 
suppuration between the layers of the cornea ; 
staphyloma, protrusion of iris, etc. 

Sclerotica. — Inflammation — rheumatic, 
syphilitic, etc. Tumors. 

Chambers. — Lining membranes inflamed; 
may contain blood, pus, hydatids, etc. 

Iris. — Inflammation (iritis) — syphilitic, with 
nodules of a reddish or dirty brown color along 
the margin; traumatic, from penetrating 
wounds ; rheumatic, dull and discolored with- 
out nodules; scrofulous. Cysts, melanomata, etc. 

Xjens. — Inflammation (very rare), opacity 
(cataract) with induration, softening, or a gela- 
tinous or fluid state. 

Glaucoma. — {Inflammation of Choroid). — 
Eyeball hard, cornea dull, iris slate-colored. 
Fluid contents of the orbit increased and tur- 
bid 

Hetina. — Inflammation — increased vascu- 
larity, exudation, dulness, sometimes extrava- 
sation of blood ; suppuration ; displacement by 
injuries, sub-retinal efl'usion, etc. 

Tumors — scrofulous and others ; glioma. 

Amaurosis may be due to an anaemic state 
of the retina, embolism of the central artery 
of the retina, detachment of the retina (from 
injury), inflammation of the optic nerve (shown 
by swelling and vascularity), tumors in the 
brain, syphilitic deposits, haemorrhage, abscess, 
atrophy, softening, etc. 

Cancer. — Scirrhus rare ; most frequent is 
colloid or melanotic. 

Glioma is not really cancer ; it is formed 
of round-celled sarcoma. 



ORGANS OF SPECIAL SENSE. 121 

EAR. 

Auricle. — Hypertrophy, inflammaticn, tu- 
mors, etc, gouty deposit (urate of soda); haema- 
toma — effusion of blood (no doubt from injury), 
this may be absorbed, and then leaves the car- 
tilages in a wrinkled state. 

There is a peculiar fungus disease liable to affect the 
subcutaneous cellular tissue, from inoculation, and pro- 
duce extensive disorganization. 

Meatus, — Foreign bodies ; inflammation 
(lining membrane swollen and vascular); ab- 
scesses (follicular), sometimes they produce nec- 
rosis of the bone ; myxomata (polypi); eczema. 

Internal Ear, — Tn all cases of deafness 
the internal ear should be examined by break- 
ing away the roof with a chisel. There may 
be ankylosis of the stapes, disorganization from 
inflammation, caries, or various deposits; ob- 
struction of the Eustachian tube from thicken- 
ing of the mucous membrane, etc. 

NOSE. 

The interior of the nostrils may be easily exposed, 
without disfigurement, by raising the upper lip, sepa- 
rating the mucous membrane from the superior maxilla 
and dividing the fleshy part of the columna. 

Lesions. — Hypertrophy, inflammation, ul- 
ceration (syphilitic, etc.), lipomata, polypi and 
other tumors; worms or larvae sometimes get 
up the nose. 

In sudden unaccountable death look for for- 
eign bodies, as piece of tobacco pipe, etc., poked 
up the nose into the brain, through the eth- 
moid bone. 

SK5N. 

Hypertrophy. — Horny growths, corns, 
ichthyosis (thick and rough, like fish skin); 
elephantiasis (as of the scrotum, etc.) Atrophy 
in old age, syphilis and various cachexise (thin, 
dry appearance; surface chaffy or brawny, or 
greasy and lustrous) . 

Change of Color. — Addison's disease 
{melasma supra-renale), skin of a deep brown or 



122 POST MORTEMS. 

greenisli brown hue. This disease is thought 
to be dependent on some affection of the sym- 
pathetic nerve. 

Skin Diseases. — Psoriasis (the red, scaly 
patches become pale after death); lichen; pity- 
riasis rubra, general redness with slight ap- 
pearance of excess of epidermic scales; pityri- 
asis versicolor (chloasma), buff-colored patches. 
Purpura, peiechice (small effusions of blood). 
Eczema, herpes, lupus, etc. 

Scleriasis (Fagge), formerly called Keloid, a 
swollen or brawny appearance of the skin, 
something like a cicatrix, for which it may be 
mistaken. 

Syphilitic Tubercles. — Solid swellings of the 
skin ; in size from a lentil to a hazel nut, and 
covered with epidermis. 

Condylomata. — Generally near the genital 
organs ; they are warts. 

Xanthelasma (Vitiligoidea). — Two forms — 1, 
X. Plana, as an opaque,~yellowish-white patch, 
not elevated, most on the palms of hands, scro- 
tum, ears, eyelids, etc. ; 2, X. Tuberosa, tuber- 
cle-like knots on the elbows, knuckles, etc. 
Associated with jaundice. 

Cancer. — Epithelioma, in form of warts ; epi- 
dermis thickened, opaque, yellow, cheesy and 
brittle ; it may be ulcerated, and then takes 
the form of- a deep irregular excavation sur- 
rounded by fungous warty growths. 

Desquamation of the skin takes place in more 
or less large patches in scarlatina, gangrene, 
from blisters, erysipelas, etc. Post-mortem 
separation from decomposition must not be 
mistaken for these pathologic effects ; there 
will in this case be other signs of decomposi- 
tion. 

THE BONES. 

The chief affections in which it is necessary 
to examine the bones are — injuries causing 



ORGANS OF SPECIAL SENSE. 123 

inflammation, necrosis, nodes, fracture, etc. ; 

syphilis, scrofula, osteomalacia (mollities os- 

sium); rachitis (rickets); caries (of the bodies 

of the vertebrae produce spinal curyature). 

The most convenient bone to take for examination is 
the femur, the thigh being opened in the course of the 
vessels, that is, from the centre of Poupart's ligament to 
the middle third of the thigh. To find the centre of 
ossification, open th© knee joint, expose the end of the 
femur, and gradually pare down the cartilage, till a col- 
ored point is noticed; the size of this must be carefully 
measured. 

Periosteum. — May be red, swollen with 
effusion (acute periostitis); less red, more swol- 
len, denser, and generally adherent (chronic 
periostitis); pus under the periosteum; circum- 
scribed thickenings (nodes are signs of syphi- 
lis); a dense, hard, heavy tumor, like tendon, 
osteoid chondroma (or cancer), very malignant. 

Bone. — Bare, white or yellow ochre (color 
result of periostitis); necrosed, sequestrum en- 
closed in a shell of new bone, with or without 
cloacae; caries; indurated; more porous (rare- 
f active inflammation). 

InfLammation within the medullary canal 
(osteomyelitis), deep redness, small suppurating 
patches or abscesses (frequent cause of pyaemia). 
Thin scale of bone detached, surrounded by 
sinuous grooves formed of eroded bone (as on 
the skull in syphilis). 

Hypertrophy.— Either from deposit on 
the surface or condensation of tissue. 

Atrophy from inflammation, injury to nu- 
trient artery, want of use, etc. — Absorption and 
expansion of tissue, sometimes producing a 
porous state (osteoporosis); or there may be 
softening of the tissue by absorption of the min- 
eral matter and substitution of fatty or gelatin- 
matter (osteo-malacia). 

Fracture. — Callus is formed where bones 
do not meet evenly. This will give the prob- 
able age of the fracture. At first lymph is 



124 POST MORTEMS. 

effused, which hardens; then bony spicules 
appear, and so a spongy mass is formed; the 
ossification commences about the third week; 
the "modeling" takes three or four months 
to complete. In deciding as to fracture of the 
neck of the femur regard must be had to the 
natural changes incident to old age. 

Tumors. — Exostoses, osteomata (growing 
from the bone), osteophytes (more superficial, 
not continuous with the bone, from which they 
differ in texture); enchondromata are lobulated 
cartilaginous tumors, non -malignant ; fibromata 
(rare, chiefly in the jaw); sarcomata, of a soft, 
fleshy, or tough consistence, may ossify and 
produce osteo-sarcomata. 

Endosteal sarcomata and myeloid tumors grow 
within the medullary canal ; they are generally 
of a deep crimson color, dry and soft ; myxomata 
(tumors like jelly); o/ngiomata (nature uncer- 
tain). Hcematoma (from effusion of blood). 

CephalhcBmatoma is a tumor met with on the heads of 
new-born children during labor. 

Cancer (rare), generally secondary as a soft 

tumor within the medullary canal; tubercle 

(doubtful); hydatid (rsire). 

JOINTS. 

Inflammation. — Simple Arthritis. — Red- 
ness (injected), effusion, often containing flakes 
of lymph, pus (in severe cases); pulpy degen- 
eration, the effusion having formed a soft thick 
tissue. 

Chronic Arthritis (Rheumatic), — Follows in- 
jury or rheumatic fever. In its early stage as 
a simple inflammation; after a time nodular 
masses form round the edge of the joint; then 
the cartilage is destroyed ; the surfaces of the 
bone are polished and gradually worn down. 
This disease is frequently mistaken for old- 
standing fracture or dislocation. 

Gouty Arthritis is shown by a white, chalk- 



SIZES OF THE DIFFERENT ORGANS. 125 

like deposit of urate of soda in and around the 
joint. Phosphate of soda may also deposit in 
the same way. 

Loose Bodies often form in the joints, 
from a millet seed to a small almond in size ; 
they are composed of fibrous tissue ; their path- 
ologic import is undetermined. 

Rheumatisin. — Acute (morbid appearances 
have not been observed much). — Sometimes at 
first little change, at other times there is a pink 
color ; or there may be effusion, with flakes of 
lymph. Chronic. — Swollen condition of the 
membrane, otherwise not much change. 

Scrofulous Inflammation ( White Swell- 
ing). — In its early stage it has been seldom 
seen, but then as acute inflammation. Later 
Stage. — Synovial membrane is of a deep red 
color, eroded in parts; this increases till all 
of it is destroyed ; the pus is most offensive. 

Pysemic, sjonorrhoeal, puerperal, and scar- 
latinal "rheumatism'^ are all inflammations 
due to septicaemia. 

For the first few days the joint contains thin, dirty- 
colored pus ; then destruction of the synovial mem- 
brane takes'place. 



XII. 

VARIATIONS IN THE SIZES OF THE 

DIFFERENT ORGANS. 

Prof. Beneke has reached the following con- 
clusions, which have been published in a re- 
cent circular of the War Department : 

1. Before puberty the aorta is smaller^ than 
the pulmonary artery; after this period the 
relation begins to be reversed, and in advanced 
life the aorta is always the largest. 

2. The aorta and pulmonary artery are ab- 
solutely smaller in the female than in the male, 
but relatively to the length of the body there 
is scarcely any difference between the circum- 



126 POST MORTEMS. 

ference of the arteries in the two sexes, while 
the heart in females is absolutely as well as rel- 
atively smaller than in males. 

3. In adult males the volume of the lungs is 
greater than that of the liver ; in adult females 
the reverse seems to be true. 

4. In men the volume of the two kidneys is 
nearly equal to that of the heart; in children 
it is greater. 

5. Children have relatively larger intestinal 
canals than adults. 

6. Sudden increase in the size of the heart 
occurs at the age of puberty. 

7. The iliac arteries diminish in size during 
the first three months of life. 

8. The cancerous diathesis is in the majority 
of cases associated with a large and powerful 
heart and capacious arteries, but a relatively 
small pulmonary artery, small lungs, well de- 
veloped bones and muscles, and tolerably abun- 
dant adipose tissue. 

Pulmonary tuberculosis is often associated 
with an unusually small heart. 

10. In constitutional rachitis, the heart is 
generally large and well developed ; the arte- 
ries are also large. 

THE POST-MORTEM APPEARANCES IN NEW- 
BORN CHILDREN WHERE DEATH HAS BEEN 
CAUSED BY SUFFOCATION. 

Nobiling, in the Arizliches Intelligenzblaitj 
gives the following'summary as the results of 
his investigations : 

1. Extensive hemorrhages into the skin are 
caused by external violence— difficult labor, 
operative procedures and endeavors to resusci- 
tate being excepted. 

2. Hemorrhages into the muscles of the neck 
and along the great vessels always point to 



SIZES OF THE DIFFERENT ORGANS. 127 

attempts at choking, with the same exception 
as in 1. 

3. The following likewise always indicate 
external violence : Hemorrhages between the 
capsule and substance of the liver, or in the 
organ itself; tearing of the peritoneal covering 
or the parenchyma of the liver, spleen or kid- 
neys (not a rare occurrence when restoration to 
life has been attempted). Furthermore, hem- 
orrhages into the umbilical cord occur very 
rarely during labor or the performance of arti- 
ficial respiration ; they are caused, for the most 
part, by tearing or attempting to tear the cord. 

4. Hemorrhages of great extent into the skin 
arise from difficult labor or external violence ; 
hemorrhages into the lips, tongue, gums or 
mouth are always suspicious. Swelling of the 
lips — apart from its occurrence in face presen- 
tations — is always to be considered an indi- 
cation of violence; so should be considered 
hemorrhages into the external auditory canal 
or auricle. 

5. Effusions of blood into the muscles except 
the muscles of the heart, eye and tympanum, 
are always caused by external violence. The 
same exceptions are to be made here as in 1. 

6. The substances, fluid or solid, through 
which suffocation has . ensued are usually to be 
found in the respiratory and digestive tracts, 
in the drum of the ear and the Eustachian 
tubes — indeed almost always in all of them. 

7. Blood in the larynx, trachea, bronchi and 
alveoli has been sucked in by inspiration ; it 
has come from th« nose of the child or the par- 
turient canal. To a similar source is to be at- 
tributed blood found in the mouth, oesophagus 
or stomach. 



128 POST MORTEMS. 

xrii. 

POST-MORTEM WOUNDS. 

It is hardly necessary to say that the utmost 
care must be taken during a necroscopy not to 
prick or scratch the skin, especially so if the 
subject has died of peritonitis, puerperal fever, 
erysipelas, scarlet fever, and other zymotic dis- 
eases ; also when the body is in a state of de- 
composition. 

If the skin is injured before commencing the 
examination, apply Friar's balsam, tincture of 
tolu, or collodion ; then cover with several lay- 
ers of sticking plaster, and grease or wax this 
well, so as to make it water-proof. 

If the skin is injured whilst performing the 
necroscopy, wash in cold water, suck well, and 
afterwards bathe or soak it in a mixture of 
dilute sulphurous and carbolic acid, as strong 
as can be borne. It must be remembered, how- 
ever, that strong carbolic acid will produce a 
painful sore, and that both these acids in dilute 
form, applied for some time, will destroy the 
epiderm; but this last effect is not of much 
consequence. 

The Editor has always used a pencil of nitrate of silver 
pressed well down into the wound. 

The painful inflammations which often arise 
from post-mortem wounds are relieved by paint- 
ing the part with strong perchloride of iron 
solution. If constitutional symptoms show 
themselves, as inflammation of the lymphatics 
these are best met with hyposulphites, of which 
the magnesic are the most efficacious; they should 
be taken very frequently, as every two hours. 
The sulphurous acid applied locally and the 
hyposulphites taken internally are so powerful 
in counteracting septicaemia that by their use 
blood-poisoning may be almost entirely pre- 
vented. 



INSTRUMENTS REQUIRED. 129 

xiy. 

INSTRUMENTS BE QUIRED. 

The fewer instruments the better when the 
necroscopist has to carry them all with him, 
but in a well-appointed mortuary everything 
that can assist, even in minute details, should 
be provided. 

1. Scalpels. — Three or more of moderate 
size, with rather broad blades, the cutting edge 
curved and the points blunted. Two or more 
of the usual kind for special purposes, and a 
large one for cutting the cartilage of the ribs. 
A long, thin, moderately wide-bladed knife, 
for slicing the brain, kidneys, etc. A Valen- 
tine's knife is very useful for making micro- 
scopical sections. 

2. Saw. — This may be an ordinary meat or 
dove-tail saw, with or without a movable back ; 
a special saw or raehitome^ for opening the 
spine, is often required. 

3. Scissors. — Straight and curved, also a 
pair for cutting the intestines, one blade hook- 
shaped (enterotome); it is useful also to have a 
a bronchotome, or narrow, unequal-bladed scis- 
sors, for opening the bronchi and blood-vessels. 

4. Forceps.— These should be longer and 
stronger than the ordinary dissecting forceps. 

5. Hooks. — Best mounted in handles ; those 
on chains are dangerous ; hooks may be extem- 
porized out of bent wire or pins with string 
attached. In fact, pliable copper wire will be 
found very serviceable for various purposes. 

6. Mallet and Common Chisel.— A 
layer of leather or rubber on the striking part 
of the mallet serves to deaden the sound of the 
blows. 

7. Tape Measure.— Made of stiff cloth. 

8. Spring Balance — or beam scales— to 
weigh from a quarter of a pound up to ten 



130 POST MORTEMS. 

pounds. In the mortuary a larger one should 
be provided for taking the weight of the entire 
body. 

9. Needles. — These must be strong, curved 
and with cutting points 3 to 5 inches long. A 
few smaller ones are sometimes needed. 

10. Cord. — Nothing answers better than 
the coarsest crochet cotton, or very even string, 
which should be well waxed before using. 

11. Pins with and without guarded points. 
These last are serviceable for fastening up holes 
in the intestines, stomach, etc. 

12. Bone Forceps.— Large and powerful, 
hawk's-beak shaped are best. 

13. An Iron Ring, with three screws to 
fasten to the head to guide the saw, and with a 
handle to steady the head. 

14. Several Blocks of Wood to sup- 
port the head; in the mortuary, however, a 
head-rest should be attached to the table with 
adjustable screw slide. A modificat/on of the 
iron ring and head-rest combined is very good. 

15. Various Minor Necessaries. — 
Sponges, calico rollers, cloths, pieces of oiled 
silk or gutta-percha tissue (for taking away 
specimens), blow-pipe. India-rubber gloves, 
Coddington or Stanhope lens, hone, pots and 
jars for speoiciens, etc. In a well-appointed 
mortuary provision should be made for pho- 
tography. 

16. Disinfecting Solutions. — Perman- 
ganate of Potash, or Condy's Fluid; Sir W. Bur- 
netCsy or Chloride of Zinc. — This latter solution 
is colorless, inodorous, and, diluted, preserves 
tissues almost for ever. 

Sulphurous Acid is the most valuable, remov- 
ing the cadaveric odor and preventing post- 
mortem sores ; this, combined with about a 
fourth part of carbolic acid to ten parts of 
water, is perhaps more efficacious. 



ORDER OF EXAMINATION. 131 



Bond^s Terebene sprinkled over the body 
removes much of the unpleasant smell. 

Carbolate of Soda and dilute Carbolic Acid are 
very useful. 

The Illustrated Medical Journal Co., 
Instrument Dealers, Detroit, Michigan, offer 
the following compact Post- Mortem Case for 
110.50. It contains: 




1 Large Knife and Saw in one Handle; 1 
Tenaculum ; 3 different sized Scalpels ; 1 An- 
eurism Needle; 1 Pair Forceps; 1 Pair Scis- 
sors ; 1 Set Chain Hooks ; 1 Blow Pipe ; 1 Post 
Mortem Needle ; 1 Chisiel. Knives, etc., have 
ebony handles. All in polished Mahogany 
Case, with Lock and Key. 



XV. 

OEDEB OF EXAMINATION AND TA- 
BLE FOB NECBOSCOPIC BECOBD. 

PRELIMINARY OBSERVATIONS. 

Place where necroscopygwas conducted — date 
— name of deceased — age — place where seen:— 
persons present — remarks on their behavior, 
etc. — state of locality — objects near. Measure- 
ments of distances to be accurately made. 



132 POST MORTEMS. 



EXTERNAL EXAMINATION. 

Appearance of Body. —- Condition- 
position — clothing — height — weight — muscu- 
larity — proofs of death. Objects likely to have 
caused death, as knives, cords, bottles, etc., 
notice how and where they are placed. Pre- 
serve any vomited matters, also blood-stains. 

State of the Skin. — Clean or dirty, nat- 
ural or acquired color. Signs of decomposition. 
Marks of injury, disease, tattooing, naevi, warts, 
scars, etc. 

Condition of mammae ; silvery lines of preg- 
nancy on abdomen and breast. 

State of the Natural Orifices.— Eyes, 
ears, nostrils, mout>^, anus, urethra, vulva. Look 
for foreign bodies, signs of wounds, etc., in these. 

State of the Limbs.— Position ; rigor 
mortis. Size of hands and feet; delicately or 
coarsely formed, showing signs of handicraft. 
Special marks. Condition of the nails; con- 
tents (blood, dirt, grass, etc.) 

Features. — Relaxed or contracted ; eyelids 
closed or open ; condition of cornea and pupils. 
Mouth ; contents, position of tongue, state of 
the teeth. 

Carefully examine the Spine for disloca- 
tions, fractures, punctures, etc. 

INTERNAL EXAMINATION. 

Thorax uncovered (not opened), abdomen 
opened. Amount of fat or its absence on chest 
and abdomen. Wounds. State and position 
of the undisturbed abdominal contents, perito- 
neum, mesentery, etc. Foreign bodies ; disease. 
Position of the diaphragm. 

Thorax Opened. — Position of thoracic 
organs. Pericardium; mediastinum; pleura 
(undisturbed). 



ORDER OF EXAMINATION. 133 

Heart. — Shape, appearance, weight. State 
of coronary vessels. Bulging of auricles and 
ventricles ; fat. 

Cavities. — Clots; muscular structure; valves. 

Vessels, — Aorta, pulmonary artery, vena cava, 
etc. 

Larynx, Trachea, Bronchi, etc.— Ab- 
normalities, foreign bodies, disease, etc. 

Lungs. — Pleura — adhesions, contents. 
Eight and left lungs — color, consistence, ap- 
pearance, weight, etc. 

ABDOMEN. 

Liver. — Form, weight, consistence. 

Gall Bladder. 

Pancreas. Spleen. 

Kidneys. — Bight and left; appearance of 
cortical and medullary substance ; weight. 

Supra-renal Capsules. 

Semi-lunar Ganglion. 

Stomach. — Size, appearance, contents. Tie 
up both the ends before removing ; and, if nec- 
essary, seal the whole up at once in ajar. 

Peritoneum, mesentery. 

Intestines. — Duodenum, ileum, ileo-csecal 
valve, appendix cseci, caecum, colon, sigmoid 
flexure, rectum. Appearance, position, con- 
tents, disease, etc. 

Bladder. — Full, empty, state of mucous 
membrane. Prostate ; urethra ; penis, testicles, 
etc. 

Uterus, vagina, etc., poisons may be intro- 
duced per vaginam ; ovaries, state of the Graa- 
fian vesicles, etc., Fallopian tubes, etc. 

HEAD. 

Scalp, bones, fontanelles. 

Brain. — Dura mater and arachnoid ; pia 
mater — superior surface, base, fissures. Grey 
matter, white; ventricles — 1st and 2nd, 3rd, 



134 POST MORTEMS. 



4tli and 5th. Corpus striatum, optic thalamus. 
Velum interpositum, choroid plexus, etc. 

Base of skull, fractures, caries, tumors, etc. 

Spinal Cord.— Marks of injury, disease, 
etc., in the vertebrae and in the cord itself. 
Dislocation of the atlas. 

OKGANS OF SPECIAL SENSE. 

Ear. — External meatus, disease, injury, for- 
eign bodies. Inner ear. Eustachian tubes. 

Nose. — Disease, foreign bodies, punctureS 
through the ethmoid bone. 

Eyes. — Eyelids, orbit, cornea, lens, cham- 
bers, retina, optic nerves. 

Bones. — Fractures, dislocations, shape, col- 
or, length, disease, etc. Centres of ossification 
in clavicle, maxillary bones, sacrum, pubes, os 
calcis, sternum, clavicle, femur. Examine the 
shape, size, etc. of the pelvis. 



INDEX. 



PAGE 

Air in Veins 108 

Addison's Disease 79 

Arachnoid 106 

Asphyxia 15 

Atrophy of Liver 73 

Bladder 8) 

Body, External Examination 7, 25 

Bones 122 

Brain , HO 

Bright's Disease 82, 83 

Bronchi 44 

Cadaveric Rigidity 10 

Cancer of Stomach 57 

Cancer, Uterine 97 

Cholera 68 

Circulation, Organs of 30 

Clitoris 101 

Death, Signs of .....9-17 

Digestive Tract 53 

Disinfecting Solutions 130 

Drowning 18 

Dura Mater 105 

Dysentery 68 

Ear .....121 

Embolism 41 

Emphysema 49 

Endocardium 33 

Examination of Body 25, 131 

Eye and Lids 119 

Fallopian Tubes 93 

Gall Bladder 75 

Generative Organs, Male 86 

" Female 90 

Hanging 17 

Head, Examination of 27, 103 

Heart : 31 

Hepatitis 72 

Hernia 65 

Hodgkin's Disease 77 

Hydrocele 87 

Infanticide 11 

Injuries of Brain 115 

Insanity 116 

Instruments Required 129 

Intestines 62 

Invagination ." , 65 

Joints 124 

Kidneys 79 

Lateral Ventricles 113 

Larynx 44 

Leuksemia 77 

Ligaments, Uterine 91 

Liver 70 

Lungs 47 

Lungs in Newly Born , , 53 

Lymphatic 41 

Malformations 11-16 

Mammse 102 

Meningitis 107 

Menstruation 98 

Mouth 53 

Nerves 119 



136 INDEX. 



PAGE 

Nervous System 103 

Nose 121 

CEsophagus 55 

Orfices of Heart 37 

Organs, Variations in Size 125 

Ovaries ^. 91 

Pacchionian Bodies 105 

Pancreas 76 

Parturition 98 

Pelvis, Female 90 

Penis 88 

Pericardium 30 

Perinseum 102 

Peritoneum 59, 100 

Pia Mater 106 

Pharynx 54 

Phlebitis 40 

Phlegmasia Alba Dolens 40 

Phthisis 49 

Pleura 46 

Pneumonia 50 

Poisons, Signs of. 21 

Poisons in Stomach 58 

Portal System 70 

Post-mortem Wounds 128 

Powder Marks 19 

Preservation of Tissues 28 

Prostate Gland 88 

Puerperal Fever 99 

Eape 100 

Respiration Test 12 

Respiratory System 42 

Rheumatism 125 

Scrotum 86 

Sewing up Body 29 

Shape of Heart 37 

Signs of Death 17 

Skin 121 

Skull cap 104 

Solutions, Disinfecting 130 

Spleen 76 

Spermatic Cord 88 

Spinal Cord 116 

Starvation 17 

Stomach 55 

Suftocation 17-126 

Supra-Renal Capsules 78 

Suicide 19-17 

Syphilis 73 

Testicle 86 

Tongue 54 

Trachea 44 

Typhoid Fever Lesions 66 

Urjemia 109 

Ureters 80 

Urethra, Male 89 

Urinary Organs 78 

Uterus 94 

Vagina 99 

Valves of Heart 37 

Veins 39 

Viability H 

Vulva 100 

Waxy Liver 74 

Wounds, Post-mortem IS 



IXTSTRTTMENTS 




JSJT 



50 PER CENT. DISCODNT. 



We Discount usual Catalogue Prices of SURGICAL or DEN- 
TAL INSTRUMENTS, BATTERIES and APPARATUS and 
BOOKS, from 15 to 50 Per Cent. 

Write us for LOW Prices on Instruments, etc., that you wish. 
Get your HIGH Prices elsewhere. 

. A FE^¥ OFFERS: 

BI^^Ii'rTINfl ffi^PR Leonard's "Ever Ready,'* $2. Contains 
l/iOOrjtlinU IfiiOriO lScalpel;lpr. Scissors; 1 pr. Forceps; 1 
Tenaculum; 1 Cartilage Knife; 1 het of Chain Hooks; 1 Blow Pipe. 
Ail in Wood Case and sent post paid. 

DAPITFT TfiQl? Leonard's *'Multum in Parvo" Pocket Case, 
f UUilDl UaOlJ (20 instruments) $8. Contains 1 Scalpel ; 1 Tenac- 
ulum; 1 Gum Lancet; 1 Sharp-pointed, curved Bistoury ;1 Thumb 
Lancet; 1 Combined Spatula and Tongue Tie; 1 exploring Needle 
in Case; 1 Combined Male and Female Catheter and Caustic Holder; 
1 Combined Torsion, Polypus, Artery and Needle Forceps;! Plam 
Artery Forceps; iPr. Probes; 1 Combined Director and Aneurism 
Needle; 3 Needles; 1 Tablet of Silk; 1 Probe-pointed Bistoury. All 
in a neat, two-fold, Silk and Velvet-lined Morocco Case. 

TUyPMAMIi'T'CPQ -A- warranted, accurate, self-registering, inde- 
inDRlttUlUEilEiriO structible index, latest pattern, in a hard 
rubber case, post paid, $1 00. 

TAATTI PAPri?!)^ Nickel-plated, octagonal joints, warranted. 
lUUifl lUIVvrirO Four pair for $5; three pair for $4; two pair 
for $2 70. All post paid. 

QTH'TUAQrABrQ Bi-aural, soft rubber tubes, postpaid $2 00 

OiI!iinU0V;Uri:iO Camman's hi-aurcX " $1 75 

"DAppr'PQ ElUotVs Obstetric, with Fcrew in handle, nickel-plated, 
iUilVjDrO postpaid, $5 00; Thomas', $4 50, post paid; Hodges', 
$4 50, post paid. Uterine, long dressing, $1 15, post paid. 

nVBAI\FPMTP QVPTMfU'Q In a neat case, with bottle and two 
nin/UDRlllll; OiiliilUDO gold-plated needles, screw-heads, 

fenestrated metal barrel, washers, etc., post paid, ^1 15. 
Uterine Applicators, post paid, 60c. 

Panquelin's Thermo-Cautery, 2 points Complete, in Case, 5^28. 
Stomach Pump, Aspirator and Syringe Combined, $12. 
THE ILLUSTRATE MEDICAL JOURNAL CO., 
Surgical Instrument Manufacturers and Dealers, 

Leonard B ock, i8 John R. St,, Detroit, Mich, 
All the abov^ *'offers'* post p lid on receipt of price. 



